Doctors should be held to account when their conduct or performance poses risks to patient safety. However, in the MDU's experience this is not the case for the overwhelming majority of doctors who are considerate, conscientious and trying their excellent best. As all the evidence shows, clinical outcomes are improving in general practice and hospital settings.

The impulse in public life to impose a flawed doctrine of infallibility on medical professionals and then seek to punish individuals for perceived failures is pernicious. It is evident in the expanding list of 'never events' which are deemed 'intolerable and inexcusable' within NHS hospitals. As Dr Michael Devlin points out in this issue, the term 'never events' engenders emotions of disbelief and outrage which can be a distraction from ongoing and necessary patient safety initiatives.

I believe the blame culture has detrimental effects on doctors, the health service and society at large. As the Health Secretary acknowledged:

'The rush to blame may look decisive. It may seem like professionals are being held accountable. In fact, the opposite can happen. By pinning the blame on individuals, we sometimes duck the bigger challenge of identifying the problems that often lurk in complex systems and which are often the true cause of avoidable harm.'

Climate change

In my view there is a very real danger of creating a climate where this unremitting focus on failure and individual culpability has a corrosive effect on public confidence in the profession and on the professionals on whom we all rely to care for us when we need them.

The MDU believes doctors should not have to practise in fear but be able to focus on providing the best possible care for their patients. We have long called for an open and transparent culture in which errors are reported and learning is shared to improve patient safety. Since the 1950s, we have advised members to tell patients when something has gone wrong, apologise when appropriate and make every effort to put things right, and we stress that patients are entitled to a prompt, sympathetic and truthful account of what has happened.

However, fundamental cultural change is needed to reverse the blame culture that has taken hold in the health sector, before the damage it does is irreversible. This requires a renewed focus on fair and transparent incident investigations by hospital trusts, the responsible and proportionate exercise of scrutiny by the regulators, and reform of the civil litigation system.

The MDU is campaigning hard to achieve these goals. But in the meantime, our members will always be able to call on us for support and representation if they become the focus of blame.

Playing the blame game in medical practice

Dr Christine Tomkins

Playing the blame game in medical practice