Dr Phil Hammond, GP and broadcaster

Have you admitted to any cock-ups recently? I donÍt mean in the bar with your mates, having a laugh about it, but seriously, in an audit meeting, having your work scrutinised. As doctors, we seem to find this very hard to do but in the new ïpost Bristol - post ShipmanÍ NHS, such openness is encouraged. Some think itÍs the key to changing our secretive, self-defensive culture into something more open and, um, safe.

Supposing Shipman had not been a murderer, just the worldÍs most incompetent and dangerous doctor. Would he have been picked up any sooner? I doubt it. Even though 71 of his alleged killings occurred while he was in a group practice, the culture of the time was not to discuss deaths at practice meetings and see if any mistakes had been made or anything could be learned from them. It was just ñOh, I see Mavis is deadî, maybe a quick glance at the notes and move on.

Part of our unwillingness to scrutinise our work is the baggage we carry from our junior doctor years. Any health service that asks so much of so few doctors is going to cut a few safety corners, and I suspect weÍve all done things we didnÍt feel competent to do, sometimes for the first time with no supervision or even no-one else in the hospital if things went pear shaped.

I recently (and according to my wife, unwisely) went on the Six oÍclock News to talk about my potassium near miss. I was a final year student, doing a locum. IÍd never put a drip in before and was called to resite one at three oÍclock in the morning. Hardly something to get the registrar out of bed for, so I bumbled through and, in my nervousness, flushed it through with an ampoule of potassium chloride rather than saline. The ampoules were identical, the light was dim, I was tiredƒ you know how it is.

Fortunately, I was so crap the drip wasnÍt in properly and the patient just got searing pain in her arm rather than asystole. I realised my error, lied (ñYou must be allergic to salineî) and carried the baggage with me without telling anyone. Now, having come clean to the nation, I came home to find my kids not playing doctors and nurses, but killer doctors and nurses.

And thereÍs more. IÍm quite a good bullshitter but not great with my hands. I realised general practice was the job for me fairly early on but the hurdle of the VTS scheme had me doing all sorts of jobs I was most unsuited for. The disasters of the Special Care Baby Unit are too traumatic to detail, so let me give you my episiotomy.

In the hospital I was working at, the midwives did all the minor tears and simple repairs, but if there was a major rip theyÍd call in the SHO with ten thumbs whoÍd never done one before. Now, men have trouble visualising the anatomy down there at the best of times, but when itÍs grossly swollen and bloody, and partly obscured by piles, itÍs no place for a dabbler. But I had a go, because thatÍs whatÍs expected of you before you ask for help. I tried to think in three dimensions, I tried to oppose the edges (and still leave a hole), and when IÍd finally finished inserting a mile and a half of cat-gut I realised the two sides werenÍt at all symmetrical. In fact one had an extra flap.

What to do? I toyed with just snipping it off (the woman, mercifully, had a functioning epidural), but decided that wasnÍt ethical and I might be condemning her never to pee, poo or have sex again. It was time to admit my limitations, though not of course to the woman.

ñIs everything all right down there?î ñFineƒ Yepƒ um IÍm just going to ask a senior colleague to have a look though. ItÍs perfectly routineƒ just for quality controlƒî Alas, the registrar on that day was Bruce, a tactless Australian motor-mouth who was irritatingly good with his hands. I tried to brief him to take a softly softly approachƒ ñBugger me, looks like the mice have been at this!î said Bruce.

Bruce unpicked my handiwork and re-sewed it beautifully. I slunk off and hid, glad for the womanÍs sake that IÍd owned up but humiliated at my failings. Which I guess is why most of us still donÍt own up. If youÍre going to cough to your cock-ups, seek out a sympathetic ear.

The new edition of Dr Phil's book, Trust Me, I'm a Doctor, is available at the discounted price of £8.99 to Guidelines in Practice readers; tel: 020 7381 0666. His new show, 59 Minutes to Save the NHS debuts at the Edinburgh Festival Fringe and is on UK tour in the Autumn.

Guidelines in Practice, September 2002, Volume 5(9)
© 2002MGP Ltd
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