The new tort invented by the court in Chester v Afshar and the subsequent evolution of case law

The court in Chester v Afshar made a radical departure from previous case law and ruled that failure to inform the patient of a material risk was a harm for which damages could be recovered even where that failure would not have affected the decision of the patient. More recent rulings naturally follow on from this decision, including the case of Montgomery v Lanarkshire Health Board and Kathleen Jones v Royal Devon and Exeter NHS Foundation Trust. Here we will consider Chester v Afshar and Montgomery v Lanarkshire Health Board.

Informed consent has evolved from the paternalistic standard of Sidaway v Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital, where it was held that the standard for determining what informed consent was determined by a responsible body of medical opinion. The medical profession set the standards for the amount of information necessary. 

The failure to provide information considered relevant by an individual patient does provide grounds for negligence where the patient would have sought a different surgeon (for example) in order to minimise the chances of a complication which was particularly important for that patient to avoid. This was the basis for causation in the case of Chappel v Hart. The claimant argued that she would have sought the most experienced surgeon possible in order to minimise the small risk of losing her voice after surgery on a pharyngeal pouch. 

Therapeutic privilege is still protected to an extent, although like the case of Kathleen Jones v Royal Devon and Exeter NHS Foundation Trust the exemption provided might be regarded as rather difficult for doctors to rely on. Where exactly does distress and anxiety naturally related to the weighing of such important decisions become "psychological harm"? Will doctors acting in good faith be protected? 

Chester v Afshar marks a sea change in consent in British law. It changes the standard of consent to subjective from objective. The onus is now on doctors to find out what the patient considers important. Since it is essentially impossible for someone to know whether a fact is important prior to knowing that fact, this means that disclosure has to be complete in reality. Further, the courts created a new tort in order for these rights to be enforceable. The infringement of autonomy, regardless of any effect of health whatsoever, is a tort.

The subsequent development in Montgomery v Lanarkshire Health Board is not surprising. The policy-based decision to not warn all diabetics about the risk of shoulder dystocia was seen as an infringement of individual autonomy. This has wide-reaching consequences, of course. The initiatives to reduce the rate of Caesarean sections will probably founder. Obstetric care is unlikely to improve overall. 

The neo-Liberal emphasis on individual choice has reached the law courts, and this does not sit easily with a national health service. 

Should we all drive Volvos?

Should we all drive Volvos?
Most people would agree that the most important factor in choosing a car if money were no object would be safety. If we assume that a Volvo is the safest car, then logically we should all drive Volvos if possible. Of course, safety comes at a cost. So should people be able to buy cheaper but less safe cars? Most people would say that this is a matter of informed choice for the individual. What if it were pronounced that Volvos were the only car that could be bought, in order to improve road safety. Many people would be priced out of the car market. It could be argued that people don't need cars - although this policy would exclude many people from various activities. It would disproportionately hit those in rural communities, who might well consider the small increased risk from a non-Volvo car worth the benefits of car ownership.
If we decide that car ownership should be widespread, the state might decide that those who cannot afford their own car should be provided with one. In that case, the poor would receive a Volvo at massive cost to the taxpayer. This would be problematic.

Let us replace the Volvo with "safe staffing levels" in healthcare. It is difficult to argue with the desirability of safe staffing levels on the wards of our hospitals. However, just as with the Volvo analogy, safe staffing levels come at a price. Simply stating that provision of safe staffing levels is a simple matter ignores all the issues that either the NHS budget would have to be expanded massively, or some people would have to be denied healthcare. Close a ward if staffing levels fall below the minimum? Where do the patients go?

Healthcare requires more than simplistic answers. Everyone likes motherhood and apple pie, but they have failed to solve the problems of the world.

NMC protecting its members from complaints

I have heard disturbing reports of the Nursing and Midwifery Council (NMC) protecting its members from complaints. One member of the NMC has been threatening people on Twitter, actions that are surely incompatible with their position. Worse of all, when complaints have been made about this person, the NMC have claimed that they cannot investigate without the individual's PIN. It seems quite inconceivable that the person involved can avoid NMC investigation because the complainant does not know what her PIN is. It smacks of the sort of cronyism that ought to have been eradicated from professional regulatory bodies in the last century. 

Psychoactive Substances Bill

The current government is trying to prevent the circumvention of legislation on controlled substances by invention of new compounds with rather broadly framed legislation against "psychoactive substances". Most of us consume psychoactive substances daily (unless we are members of the Church of Latter Day Saints, aka Mormons): we drink tea or coffee; smokers inhale nicotine; chocoholics are consuming a substance related to caffeine (theobromine). Thus food and drink which "(a) is ordinarily consumed [and] does not contain a prohibited ingredient" is specifically excluded. 

There have been wild claims that this definition still prohibits scents and scented objects including flowers. The simplest answer to this objection is that, contrary to the perceptions of some, the courts are used to interpreting statutes with common sense. The more accurate answer is that the statute if interpreted properly, and read in its entirety, does not state anything of the sort. Clearly Parliament is not intending to ban flowers. Although all sorts of sensory experiences can affect our mood, positively or negatively, they do not do this by direct stimulation or depression of the central nervous system. So as Carl Gardner argues, the "by" in the following definition

For the purposes of this Act a substance produces a psychoactive effect in a
person if, by stimulating or depressing the person’s central nervous system, it affects the person’s mental functioning or emotional state

is crucial in clarifying the effect of the bill. I would suggest adding "directly" before "stimulating or depressing" may assist in clarifying. The government is not suggesting that any stimulating experience should be criminalised, like the dystopian regime in 'Equilibrium', nor will this bill achieve that.

DNACPR

Talking about DNACPR orders, I'm reminded that my own father had a futile resuscitation attempt at the end of his life. He was found collapsed after breakfast on a hospital ward, he had been admitted with a chest infection complicating chronic lung problems caused by years of heavy smoking.

I wasn't there, I lived 2 hours away although by coincidence I was travelling down that day anyway. So I don't know if my father was aware of the resus attempts, but I hope he wasn't. My father was in a residential home with dementia and other medical problems. After my mum died, he didn't really want to live. He certainly wouldn't have wanted CPR.

As a former medic, maybe I should have thought about the issue of my father's resus status. It may have been partly that I would have assumed that a sensible doctor wouldn't have considered resuscitation. These issues should be discussed without worrying about upsetting relatives, although I think resuscitation status is a decision that the treating medical team are in the best position to decide, guided by input from the patient and/or relatives. 

Universal CPR as a secular rite of passage is misguided and an unfortunate effect of medico-legal concerns. I applaud the efforts to allow a peaceful, natural death from physicians like Dr Gordon Caldwell @drcaldwell

The peculiar exceptionalism surrounding cardiopulmonary resuscitation

Recent decisions about 'do not attempt cardiopulmonary resuscitation' (DNACPR) orders have highlighted the peculiar exceptionalism around cardiopulmonary resuscitation (CPR).

What other intervention with such a low success rate, invasive nature, potential for causing suffering, and failure to improve the underlying medical condition(s) would not only not require consent, but require a quasi-consent process in order for doctors to decline to offer it when it is futile?

Imagine an operation that had the same characteristics as CPR. The law would rightly require that doctors carefully explain the harms and benefits of such a procedure carefully, otherwise the intervention would be deemed an assault (all the more so subsequent to the decisions in Chester v Afshar and Montgomery v Lanarkshire Health Board).

However, the conversation about CPR cannot as a matter of law result in the doctor being compelled to offer a medically contraindicated and futile procedure. It is merely required to ascertain the patient's wishes. They can be ignored. Further, the mere prospect of upsetting the patient (and family) unnecessarily is not enough for this discussion to be circumvented. There has to be the prospect of harm.

This is an unacceptable interference in the doctor-patient relationship, and undermines medical professionalism. It will relegate the discussion of CPR to a technical task defined by the courts, and has the potential for completely reversing the efforts being made to enable a comfortable natural death where appropriate.

Doctors like Knut cannot hold back the inevitable forces of nature. They cannot "play God" when the demise of a frail patient is imminent and thus CPR futile (and barbaric).

Fitness to plead

Fitness to plead

The press seem to be rather confused over the issue of fitness to plead, which has been thrust into the limelight with the decision by the DPP to decline to prosecute Lord Janner on the basis that it would not be in the public interest.

If Lord Janner is not fit to plead, then it is arguably still in the public interest for this to go to court, where a judge can rule on this issue. Thereafter the jury would determine whether he actually committed the acts in question. If the jury found that he had, then he coud be placed on the sex offender's register and receive the disposals available under the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991. Someone who is unfit to plead is also unfit to stand trial, and so cannot be convicted. It follows that the person cannot be sentenced. There are a number of capacities required to be fit to plead, which revolve around being able to participate properly in the judicial process. 

The DPP has clarified that the medical opinions suggest that Lord Janner's health is so poor that it would be unjust to subject him to any punishment or disposal. The result of a trial of the facts would be an absolute discharge. The medical experts have been instructed both by the defence and the police/Crown Prosecution Service. The fact that Lord Janner is still eligible to sit in the House of Lords is irrelevant. There are no mental state criteria defined for suitability to sit in the House of Lords. Peers can be suspended, but removing them involves an act of Parliament. 

Causation =/= responsibility

Causation =/= responsibility

This Twitterer posted on Cage's comments about MI5 "radicalizing" Mohammed Emwazi: 

 

Mr. Tickle‏@MrTickle3

If you are annoyed with #CAGE's MI5 made me do it because it takes agency away, how is that different from #Quilliam's Islam made me do it?

This Tweet (intentionally or not) raises some interesting questions about the distinctions between causation and responsibility. A moral agent's actions may have a number of causes, and if you are a hard determinist (incompatibilist), you might say that his actions are caused and that person has no responsibility. 

If you are a soft determinist (compatibilist) or a libertarian, you believe that there is free will under certain circumstances. If you are a compatibilist, causation is not incompatible with free will. 

In the law, although it is recognized that many factors can contribute to an offence or act of negligence or whatever issue is in question, not all of these can be taken into account directly. In criminal law, a wider range of factors affect sentencing than affect criminal responsibility.  Thus a difficult background may reduce the sentence on the grounds that this affected the person's chances in life. However, it wouldn't provide an excuse and thereby exoneration. Circumstances that affect an individual's ability to choose may provide a defence. Duress, insanity and automatism are examples where the defendant's actions may not be considered criminal because of factors that affected his practical reasoning ability. 

The term "radicalization" full stop is problematic for me. It implies a process that at least reduces the person's moral agency, like the older term "brainwashing". Whether the term "radicalization" is used with respect to MI5 or ISIS, I disagree with it. 

There is a distinction between the two statements "MI5 made me do it" and "Islam made me do it". MI5 is an organization of people, and people are moral agents. Islam is a belief system. Blaming MI5 entails blaming moral agents, and thereby transferring some moral blame onto them. Blaming Islam entails no moral blame. Therefore the two statements are fundamentally different. 

This is without even going into the details of Cage's statements about MI5, their plausibility, and the likely agenda behind them. Cage is an organization with noted jihadi sympathizers among their ranks. They have acted for a number of individuals that have gone on to be convicted in a court. Make of that what you will.

HSMR dead and buried?

HSMR dead and buried?

The use of HSMRs for assessing the quality of healthcare or even comparing mortality rates has been much questioned in the academic community. Dr Foster is a commercial concern, who naturally have an interest in selling their product. The Academy of Medical Royal Colleges (AoMRC) have no such conflict of interest, and they published their report on international HSMRs yesterday.

The AoMRC have been looking at the comparison made by Professor Sir Brian Jarman between UK and US healthcare, where he stated there was a 45% difference in mortality. That figure was striking, and gave rise to a number of salacious headlines. A difference of that magnitude based on such a large database would be beyond the vagaries of mere statistical chance. 

However, the AoMRC noted a number of factors that made any direct comparison unreliable:

Choice of factors included in the risk adjustment model

Choice of data used to derive the model

Choice of hospitals included from each country

Choice of assuming the same level of underlying risk in each country

There were also a number of differences in coding which affected comparisons:

Differences in diagnostic practices

Differences in the number of secondary diagnoses

Differences in severity

Proportion of population deaths in acute hospitals

Their conclusion?

"We do not believe that the comparisons are valid because of the reasons we have given. More rigorous analyses using more clinically sophisticated data need to be used. This reflects the conclusion of a recent paper from the Dr Foster Unit which stated: ‘There are considerable challenges in combining administrative databases across countries, with decisions to be made regarding definitions of inpatient admissions and diagnosis and procedure groups. Interpreting the resulting case mix-adjusted in-hospital outcome rates across international boundaries is hampered by differing discharge policies and intermediate care facilities. Standard statistical models cannot take account of this without valid and complete post discharge information’.

One of the key issues is that we have no measure of the uncertainty attached to the estimate of 45%. On a simplistic level, it is quite accurate because it is based on large numbers, but uncertainty in almost all the key assumptions used in its derivation mean that we cannot have much credence that this estimate is even close to the actual value.

We would advocate comparisons of outcomes of care for specific conditions or interventions

based on high quality clinical data that enables adequate risk adjustment. Such comparisons are difficult as they require data from the two countries that are sufficiently similar as regards variable definitions, patient inclusion criteria, similar professional judgement regarding diagnostic labelling etc. Despite these challenges we would recommend that some studies be commissioned to establish if there are systematic differences in the quality of hospital care between the two countries."

So how and why did this study with such precarious findings become headline news? The usual reasons I suspect. An eye-catching headline, a chance to bash the NHS, and further validation of the utility of HSMR. Only that might just have backfired.

Case Note Review The "Rolls Royce" Form of Patient Safety Analysis?

Case Note Review The "Rolls Royce" Form of Patient Safety Analysis?

The flaws of using various statistical techniques to estimate the numbers of avoidable deaths in hospitals have been documented in this blog and elsewhere ad nauseum. Thus it should be no surprise that the DoH will be assessing avoidable deaths by the far more reliable methodology of the case note review (disparaged by Julie Bailey for her own reasons). The only superior method would be widespread post-mortems accompanied by coroner's inquests, with all the resource implications. 

This would be an exciting advance in the monitoring of hospital mortality, although it would fail to pick up the major issue of quality of care (which as previously discussed is not reflected well by mortality). It also fails to address the massive falls in post-mortem rates, despite the recognition that post-mortems (whether virtual or orthodox) continue to pick up a high rate of diagnostic error. 

Nonetheless, this move demonstrates a welcome move away from the Dr Foster model of statistical analysis. The avoidable mortality in British NHS hospitals is on a par with that of healthcare systems across the developed world, despite the apocalyptic headlines from tabloid newspapers. 

FGM prosecutions - where now?

FGM prosecutions - where now?

The criminalisation of female genital mutilation (FGM), also known as female circumcision, has not yet resulted in any successful prosecutions. This could be lauded as a great success if the evidence suggested this was because FGM had ceased. All the pointers are that this practice continues. Thus the failure of a single prosecution to be brought prompted rising criticism, until 16 months ago the first prosecution was announced. The acquittal this week of Dr Dharmasena brings some of the difficulties into focus.

Firstly, the woman did not want the prosecution brought. 

That is not necessarily a problem. The cultural conditioning of victims of particular crimes may often mean that they do not view themselves as victims. Neither is the victim's cooperation nor consent necessary for prosecution - it is the Crown who prosecutes. However, it does make a prosecution more difficult.

Secondly, the doctor claims that the suture inserted was on the grounds of medical necessity, and he did not realise that it might be illegal. 

Ignorance of the law is no excuse, although it can establish lack of the necessary mens rea in certain circumstances. However, it might affect the decision-making of the jury. The jurors might have considered that even though the offence was technically made out, the doctor's actions were not sufficiently wrong as to merit criminal punishment. In legal language, a perverse acquittal such as happened with Clive Ponting, prosecuted for revealing official secrets about the General Belgrano sinking.

Here the communication between the midwives and the doctor would be crucial. The jury when faced with judging whether that single stitch was reinfibulation (restoring the genitals to the state of genital mutilation that existed prior to childbirth) or a bona fide medical repair, may simply have been able to state with certainty that the former was the case.

So is this acquittal a sign that the law is essentially unenforceable, or simply a sign of an overzealous CPS trying to prove that it is on top of the job? 

CQC again fails to conform to the standards of transparency it sets for others

CQC again fails to conform to the standards of transparency it sets for others

I asked the Care Quality Commission what I assumed would be a fairly easy question for them to answer. Do they have a policy that gives clear and explicit instructions to inspectors not to interrupt staff involved in emergency interventions?

Apparently it is not. After several attempts, I have still not had a straight answer. The answers have ranged from the evasive ("Our inspectors have guidelines to suspend inspections during major incidents" - no, thats not the question I asked) to the outright defensive ("Inspectors are often medical staff, including from A&E's. They wouldn't interrupt an emergency procedure"). Do they have a policy or not? If not, why not? If they do, what measures do they take to ensure compliance? If an inspector has placed a patient potentially at risk by interrupting staff during an emergency medical intervention, what would be the procedure for investigating? 

Quis custodiet ipsos custodes? Who can ensure that the CQC do not blunder through a hospital causing disruption? After all, any complaints to the CQC about the conduct of their staff risk prejudicing the CQC's report on that hospital. I hope the CQC will see fit to make a proper response; after all, this is an important issue which the public and press would be rightly interested in.

How to galvanize opposition to a bill

How to galvanize opposition to a bill

I have to admit, it is a masterstroke of pure genius. If I were a practising lawyer who stood to lose a lot of work from a bill going through Parliament, how would I galvanize opinion? If I start talking about the intricacies of the law, people will probably turn off as the debate gets bogged down in arguments and opinions. The simplest and best tactic is to say that there is no debate. This is what the opponents of the Saatchi Bill have done.

The non-legal opponents of the bill have accepted this at face value. This means that the entire debate about the law is bypassed on a false premise. There are several authoritative legal opinions that the current tests for the standard of medical care are prejudicial to innovation, one example being an article by the Samantas. So the anti-bill camp should accept there are arguments for a change in the law, rather than steamroller the debate by pretending there is no intellectual support for the premise of the bill that the law can stifle innovation. Of course, even if there is a need for the law to be changed, this does not mean that the bill currently proposed is right or could not be improved. But it would entail a shift in position from the current absolutism of the anti-bill camp.

Prospective trials

Prospective trials

One of the most problematic elements of the civil trial is the retrospective analysis of the appropriateness of actions, which is inevitably influenced by hindsight. It is well known that the recollections of patients and families is influenced by outcomes, for example. The outcome of medical treatment will also influence the judgment of the medical treatment given. We see this time after time in medico-legal suits, as my recent blog about Davies v UHNS demonstrates. Although this action failed, its origins lie in the eventual diagnosis of a brain tumour. Such actions tend to encourage positive defensive medicine. 

It's ironic that those who believe so strongly in the prospective randomised controlled trial have so much faith in the retrospective legal trial. Simms v Simms is a rare instance of an innovative treatment being judged appropriate by the court prior to its administration to sufferers from nvCJD. It is a reasonable inference that one of the reasons that the hospital trust were reluctant to administer the treatment despite the families' ardent wish that the treatment be tried was the potential for medico-legal liability. 

In this respect, the approach of the Medical Innovation Bill makes sense. The appropriateness of an innovative treatment is judged prospectively, prior to the outcome. 

Hinchingbrooke fiasco exposes bad case of double standards

Hinchingbrooke fiasco exposes bad case of double standards

The Hinchingbrooke fiasco has exposed the extraordinary double standards of many commentators on the NHS. Whilst Mid Staffs brought a number of inquiries into the poor care on some wards, including an inquiry devoted to the system (which was politically motivated), the exposure of poor care at Hinchingbrooke, the first privately-run NHS hospital, has brought calls for an inquiry not into the poor care, but into the report itself!

The Daily Mail, which has been quick to monster those who have challenged elements of the press narrative about Mid Staffs, is now an emphatic denialist about poor care at Hinchingbrooke. It trumpets "evidence", which is actually merely a series of inferences and suppositions. Far from being "shocking evidence" of a stitch-up, it's simply shocking that the DM will make such a bold assertion on so little evidence.

So many patients were happy with their care at Hinchingbrooke. The same was true at Mid Staffs. 

Some indicators show that care was good at Hinchingbrooke. The same was true at Mid Staffs.

The DM claims that the report produced was influenced by political considerations. The same is contended about Mid Staffs.

It seems that the only difference is that Hinchingbrooke was run by the private sector, and therefore the DM believes that those opposed to privatization were determined to see it damned. Many have come to the opposite conclusion about Mid Staffs, that those with a pro-privatization agenda were determined to use the hospital to achieve their ends. Both may be right. It's hard to see why the DM can be so emphatic that Hinchingbrooke was a stitch-up, and Mid Staffs wasn't.

The most interesting question is whether or not Julie Bailey or James Titcombe will attack the denialists? Or is that only when it's Mid Staffs or Morecambe Bay? Or when it's a chance to attack Andy Burnham?

National Patient Safety Adviser battening down the hatches?

I don't like to indulge in tittle-tattle, but as all complainants and whistleblowers know, informal communication networks sometimes have a great deal more of the truth than the formal ones. So it seems somewhat paradoxical that apparently trenchant critics of the system who experienced obstruction are now apparently the worst culprits!
James Titcombe, the National Patient Safety Adviser at the CQC, is incredibly unpopular if the complaints I hear about him are anything to go by. He has blocked a large number of relatives and complainants who have criticized him for doing nothing, despite promises to the contrary. In fact, his behaviour seems like exactly the sort of behaviour he himself complained of.
He and other campaigners that have all had the patronage of the current government have been amazingly quiet about the Hinchingbrooke disaster, preferring to post about Andy Burnham. Rather inappropriate now that Jeremy Hunt must be held responsible for the current state of the NHS.

Fallout from Hinchingbrooke fiasco

Fallout from Hinchingbrooke fiasco

Of course it is not a valid conclusion from the failure of one hospital that privatization in the NHS is doomed to failure. The fawning over the experiment at Hinchingbrooke was always premature. Even now, the Daily Mail is resorting to conspiracy theories to explain the CQC report:

"at least one of the 35 inspectors is a member of campaign group Keep Our NHS Public and may have been unfairly critical."

Given the number of political appointees in the CQC, including a new chair who had previously Deputy Chairman of the Conservative Party and a mentally ill incompetent saved from sacking by the personal intervention of Jeremy Hunt himself, it seems unlikely that the CQC would have a team opposed to the Conservative agenda of privatizing the NHS. The Daily Mail seldom acknowledges mistakes however; it has never accepted it was wrong about MMR, for example.

Cure the NHS, the lobbying group started with the help of funding from Bill Cash Conservative MP, has been curiously quiet. We are told that they receive complaints from all over the country about poor care. It seems odd that Hinchingbrooke Hospital would be the exception. Either CTNHS are not in touch with the state of the NHS after all, or they have been covering up the inadequacies of Hinchingbrooke Hospital. They would only have to read the newspapers after all to find a case quite similar to that of Gillian Astbury.

How long will it be before Cure the NHS comment? After all, Julie Bailey gave this ringing endorsement of Hinchingbrooke Hospital, also in the Mail:
"What this shows is the potential of allowing those on the frontline to lead, as Circle do.
The potential is there within the NHS – the majority of people wouldn’t care who provides their services as long as it was safe."
Will they call for a public inquiry into care that seems to be at least as poor as that in Mid Staffs? All the criteria that were used to justify calls for a statutory public inquiry into Mid Staffs are also fulfilled for Hinchingbrooke Hospital. So those who called for a public inquiry into Mid Staffs that don't call for the same for Hinchingbrooke are guilty of rank hypocrisy.

Uses and abuses of the GMC

Uses and abuses of the GMC

The recent furore over the treatment of Mr Meirion Thomas has highlighted the fact that  a GMC referral can be a weapon in a personal dispute (just like clinical incident forms, for example). Interesting that the GMC was emphatic that it was not going to get involved in such matters, because "Meirion Thomas had a right to speak freely" according to the Daily Mail.

This statement seems at odds with previous decisions of the GMC. For example, it appealed the High Court decision in Meadow v GMC that it was for the courts to decide what the standards for providing expert evidence should be. 

Further, its apparent swift rejection of the complaints about Mr Thomas may seem surprising, given that his comments were widely seen as unreasonable and wrongly denigrating professional colleagues, contrary to GMC guidance in Good Medical Practice:

  35. You must work collaboratively with colleagues, respecting their skills and contributions.

  36. You must treat colleagues fairly and with respect.

  37. You must be aware of how your behaviour may influence others within and outside the team.

Of course, the GMC has changed its interpretation of intraprofessional duties of respect to allow the raising of concerns (a change which is long overdue). It seems to be stretching the definition of whistle blowing beyond endurance to describe Mr Thomas's diatribes as bona fide whistle blowing. 

Whistleblower - the tag that covers a multitude of sins!

Whistleblower - the tag that covers a multitude of sins!

I had an interesting conversation on Twitter with an NHS whistleblower who was quite adamant that the vast majority of whistleblowers are genuine. Of course that distinction hinges on your definition of a genuine whistleblower. For me, a genuine whistleblower is not motivated by grievance, but altruism. In fact, the source this whistleblower directed me to confirmed that the majority of whistleblowers are motivated by grievance.

It seems that this is the justification a la mode - dinosaur Mr Meirion Thomas has now swathed himself in the cloak of whistle blower-hood, according to the Spectator and the Daily Mail.

It may seem a bizarre argument to proclaim the right to free speech whilst monstering those who have exercise their free speech in response to Mr Thomas...well, let's face it, it is! Some of the wilder calls for action against Mr Thomas can be debated certainly, but it has always been a matter of professional etiquette to only make reasonable comments about professional colleagues. 

Mr Thomas was referred to the GMC, but the GMC promptly threw the case out. Some might be surprised at this unusual demonstration of common sense by the GMC. In fact it has been pointed out this position contradicts GMC guidance on social media, however misguided that is.

Sometimes someone gets flak not because they're a whistleblower, but because they're a "T****"!

(as per printed in the Daily Mail: the actual word used is a mystery - what expletives begin with T and have 5 letters?)