The medical profession is - and knows itself to be - endemically conservative and conformist. The rash of healthcare scandals we've seen - whether in mid-Staffordshire hospitals, Winterbourne View or homes for the elderly - all share the same characteristics: abuse happens out in the open where many people can see it, large numbers of people are involved and these scandals go on for a very long time. For this to happen requires that everyone - doctors and nurses - conforms to the same wilful blindness.
I've written about this for years and more recently advocated for the abolition of gagging clauses and the imposition of a responsibility to inform. But we know and have known for decades that the medical professions are inherently obedient and conservative. If you ask medical students before they start their training, whether they would comply with an order to do something only questionably ethical, most will say 'yes'. But when you ask them the same question after they've completed their training, more will say 'yes'. This is known within healthcare circles as the 'hidden curriculum' which teaches medical students that your first duty is to obey the people around you and to stick together.
This came out loud and clear when Steve Bolsin blew the whistle on the dangerous pediatric cardiac surgeon, James Wisheart, in 1995. Bolsin's wife worked in the hospital and overheard other doctors talking about Wisheart but when she challenged them on their failure to do anything, they simply shrugged and said that doctors had to stick together.
Today, when nurses are being urged, in effect, to go back to school and retrain, the implication is that the more recent scandals were all the fault of nurses. Why? Presumably because they are easier to pick on: mostly female, further down the pecking order and therefore less powerful. But the truth of the matter is that medicine attracts a conservative mindset which medical training reinforces.
The challenge therefore isn't to retrain nurses but to consider how you create organizational cultures where individuals feel free to speak up when they identify problems. This is exactly the same problem as we've witnessed in banks - with the difference that lives, not interest rates, are at stake and the population is going to be harder to change. But don't pick on the nurses. How can they speak up when doctors won't?
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