Doctors warn that 'club culture' among surgeons is costing lives

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The lives of NHS patients are being sacrificed by doctors who have resisted the introduction of measures to detect substandard practice among their colleagues, a report says today.

The medical profession is hampered by a culture which has been "prepared to tolerate poor practice from a minority through a misplaced sense of collegiality," it says.

The scathing criticism from cardiac surgeons of the club culture of medicine comes a decade after the inquiry into the children's heart surgery disaster at Bristol Royal Infirmary (BRI) in the mid-1990s also concluded that doctors closed ranks to protect their own. It follows a report last week which showed almost one in five doctors in Britain said they had worked with an incompetent colleague in the last three years but a third failed to report the colleague.

At the launch of the report today, Andrew Lansley, the Health Secretary, will announce an extra £1.2m to fund an "information revolution" in the NHS, providing more data on doctors' performance to help drive up standards.

Death rates for every NHS trust have been published since the Bristol inquiry revealed in 2001 that children had died unnecessarily because surgeons had failed to monitor their practice. But the only publication of death rates for individual named surgeons was introduced only for cardiac surgery. In the decade since, the report says, this has led to a 50 per cent improvement in the overall risk-adjusted death rate for the specialty.

However, other specialties have not followed suit. Patients consequently remain in the dark about the safety record of other doctors treating them.

Ben Bridgewater, the lead author of the report and consultant cardiac surgeon at the University Hospital of South Manchester, said: "The political and media scrutiny of cardiac surgery after Bristol meant we were held to account in a way almost no other specialty was. The NHS is littered with failures of clinical governance and the medical profession must respond."

Cardiac surgeons introduced a traffic light system for highlighting problems which enabled swift action to be taken before the safety of patients was threatened. Among 277 cardiac surgeons whose death rates were recorded during 2006-09, 11 raised a yellow signal, 7 amber and one red. Critics of the publication of death rates for individual doctors claim they are meaningless in specialties where deaths are rare, and will lead to discrimination against high-risk patients in specialities where they are not.

Mr Bridgewater said there was still dispute about whether cardiac surgeons were being deterred from operating on sicker, riskier patients. The average age of patients having surgery had increased, indicating that surgeons were in fact accepting riskier patients, he said.

Cost was also cited as a barrier to recording death rates. Monitoring cardiac surgeons is estimated to cost £1.5m a year, less than 1 per cent of the total NHS spend on cardiac surgery, but the improved performance it has delivered means patients spend less time in hospital saving over £5m a year.

Blowing the whistle: the doctors' allegations

* "The good public standing of the British medical profession has tended to obscure the fact that over a long period of time it, perversely, has been prepared to tolerate some very poor practice from a minority of its members through a misplaced sense of collegiality (ie, we must all stick together) and dated ideas of professional autonomy."



* "The scandal involving pathologists at Bristol and Alder Hey over the retention of organs was a wake-up call for the British medical profession. Or so it seemed. While the process of renewal has started, progress has been painfully slow. Twelve years on revalidation [five yearly checks on doctors' performance] is still not operational."



* "The medical profession continues to procrastinate because some doctors, mainly among the rank and file, are determined to resist attempts to introduce meaningful assessments of their practice."

Extracts from a report of the Society for Cardiothoracic Surgery by Sir Donald Irvine, a past president of the UK General Medical Council and Frederic Hafferty, a professor at the Mayo Clinic in Minnesota.

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