Doctors whose mistakes have a negative impact on patients need more support to deal with issues around anxiety and depression, a medical conference has been told.
Dr Sorcha O’Meara told members of the Irish Hospital Consultants Association (IHCA) in Kilkenny the impact on practitioners went beyond “feeling guilt and anxiety. People describe suicidal thoughts and there have been cases of death by suicide”.
She said when “things don’t go according to plan and our patients suffer, maybe as a result of things we have done, there is an intense feeling of shame”.
Prof Kevin Turner from Bournemouth University referenced a survey of surgeons involved in “adverse events”. This suggested half suffered with anxiety afterwards, 42 per cent struggled to sleep properly and 10 per cent said they drank more alcohol.
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Almost 90 per cent said peer support for surgeons was needed, but only a quarter believed the peer support available after an adverse event was adequate.
Prof Rhona Mahony, an obstetrician based at the National Maternity Hospital (NMH), said many doctors, nurses and other healthcare professionals struggle to deal with the stress of litigation.
Citing her experience from NMH, she said midwives often “either leave practice totally or choose to practise elsewhere” after being involved in cases. This “doesn’t make patients safer; in fact it enhances risk“, she said.
Research indicated obstetricians faced a 15 per cent risk of post-traumatic stress disorder after being the subject of litigation. For many, returning to work was a more immediate issue.
“When you have a dead baby and you feel you’re responsible for that, that is really difficult,” Prof Mahony said. “But you’ve got to go back into work the next day and deal with really difficult cases again.”
She said the adversarial nature of the litigation process contributed to the problems in many instances. Prof Mahony added that a long-awaited system of “pre-action protocols” would represent a significant measure in attempts to improve the legal landscape.
Pre-action protocols refers to a set of rules requiring early engagement between claimants and doctors. It is envisaged this will cut the number of cases reaching the High Court or only being settled after the protracted involvement of lawyers.
In addition to benefiting all parties, such a move could help curb the growth in the State’s liability for medical negligence claims. The liability figure is currently estimated to stand at €5.35 billion and is increasing by 13 per cent annually. Fifteen years ago, the conference heard, it stood at €900 million.
Philip Fagan, senior clinical claims manager at the State Claims Agency, told the meeting there are currently 10,968 medical negligence cases against the State pending, with new ones lodged every week. He said he expects the pre-action protocols to be introduced next year.
Patient advocate Margaret Murphy, whose 21-year-old son Kevin died in 1999 due to a medical error, told the conference disclosure should not be about blame, but integrity, learning and prevention.
She said she had been deeply grateful for the “naked honesty” of a nurse who told her in the wake of her son’s death that it should not have happened. However, she added “in a very short time all of that was replaced with a process of damage limitation”.
She said “amazing lengths” had been taken to prevent her learning the details of what happened to her son.
Ms Murphy said she is routinely approached at events by medical professionals who tell her they can still envisage a repeat of what happened to her son happening where they work.
She recalled a fleeting encounter with one doctor who became emotional as he told her he hadn’t expected her son to die. “I felt that they had abandoned me but they had also abandoned him. I wanted to give him a hug.”
