When hard work is not enough-the Neary case

You may be familiar with the Judge Harding Clarke report where it was found an obstetrician (Neary) had been unnecessarily removing women’s wombs for many years. Some of these women were in their twenties and the unnecessary operation meant they and their partners would never have children.
Nine of Neary’s cases were reviewed by eminent Irish colleagues and they reported it was ok for him to continue practising. Intelligently the Health Board also decided to refer the same nine cases to an English consultant who raised the alarm bells. Neary was subsequently suspended. The case raises many disturbing issues but I’ll only deal with some here.

Neary is reported as being a hard working caring consultant. He thought he was doing the right thing and was saving women’s lives by his actions. He obviously was unaware of what “best practise” is when it came to excessive bleeding in cesarean sections.

For many years in order to maintain my qualified accountant status I do up to 40 hours of continuing professional development (CPD) every year. This has n’t been the case up to now with the medical world. It’s the same for teachers. Yet surely doctors and teachers have the most impact on people’s lives? (Ok so the accountants can run off with your money as Gay Byrne found but doctors’ decisions can make the difference between life and death)

The Irish consultants agreed with Neary that he would always seek a second opinion before further such operations, so they obviously had some concerns. This agreement was not included in their reports partly because they believed they were in the middle of an industrial dispute between Neary and the Health board and they did n’t want to undermine him.
They simply reviewed his case notes and did n’t look at histology reports and nursing notes. Some of these consultants were working 80 hours a week and they were doing this report as a favour to the Irish Hospital Consultant’s Association. Were they too exhausted to consider the unthinkable?
One consultant reported
“Mothers…..fortunate in having such an experienced and caring obstetrician”.
These consultants’ reputation has been totally undermined and the Patient Focus group has stated they should no longer be allowed to teach students.

So what are the lessons from this very sad situation where there are no winners?

Always take time out to develop your knowledge on an ongoing basis. Make sure you know what “best practice” is for your role and that you’re open to continuous learning and improvement

Be aware of your own weaknesses and blind spots – there’s reports that Neary would move too quickly to surgery when bleeding started

Be aware that you don’t always know best and be prepared to discuss issues with relevant people

Be prepared to challenge practices you think are unsafe. (Difficult I know in Ireland and I’ll come back to this)

And if you’re ever asked to investigate a sensitive problem area

Approach the situation with a very open mind prepared to listen to all angles.

Don’t let friendship or compassion get in the way of establishing the true situation. However respect for the people you come into contact with is vital as they’ll be more likely to work with you.

Be very analytical. Try to obtain as many facts as possible from as wide a source as possible- be it, patient problems, customer complaints, stock missing, comparisons to other similar areas. You need hard information to get to the root cause of the problem

Always keep the end customer/client/patient in mind

If you don’t have enough time or resources to complete a full investigation make sure you document the limitations of your investigation.

Hopefully none of you reading this will ever be in such a difficult situation.

Postscript 23/02/07

One of the consultants (Dr John Murphy) involved has now resigned as President of the Royal College of Physicians of Ireland following a recent Medical Council finding of professional misconduct. He stated he did not want to compromise the reputation of the College.

A new licencing scheme for GP's where they will be re validated every 5 years has been announced in Britain. This follows the case of the serial Killer GP Dr Harold Shipman. I wonder whether such a scheme will ever be brought in here ?

Neary
continuous learning
career advice
Hard work