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C7RKY's profile
John Clarke
John Clarke
John Clarke
@C7RKY

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John Clarke

@C7RKY

Of course views all mine. All without prejudice. Just a regular chap after all. Oh...and RT's may equally imply ridicule as endorsement.

UK
Joined December 2011

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    1. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      One big difference could be this. Candour is much easier when no-one has been harmed or died, and your future is not on the line, and ‘just culture’ is defined in EU law (e.g., EU Reg 376/2014). E.g., in ATC candour is about mostly losses of separation between aircraft.

      1 reply 0 retweets 1 like
    2. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      John Clarke Retweeted

      Sorry for the delay. That may be true, I agree. But I think there's a little more to the dynamic surrounding candour than just that, in the world of healthcare. It's a genuine and very serious problem. https://twitter.com/DrNHS2018/status/948209781977812994 …

      John Clarke added,

      This Tweet is unavailable.
      1 reply 0 retweets 0 likes
    3. Steven Shorrock‏ @StevenShorrock Jan 3
      Replying to @C7RKY

      Fear is at the heart of it. Fear unfolds in many ways.

      1 reply 1 retweet 1 like
    4. John Clarke‏ @C7RKY Jan 3
      Replying to @StevenShorrock

      Indeed it is and indeed it does. Any threat to your planned career is a serious one, when you start out with a £50k+ student loan. It's not the healthiest environment for candour to thrive. Or patients, for that matter.

      1 reply 0 retweets 0 likes
    5. Steven Shorrock‏ @StevenShorrock Jan 4
      Replying to @C7RKY

      It seems that the problem is, the system is set up for retributive justice first, not restorative justice. Both have a role, but in most cases of unintended harm, restorative justice must at least come first, and be fully embraced.

      1 reply 0 retweets 1 like
    6. John Clarke‏ @C7RKY Jan 4
      Replying to @StevenShorrock

      I'd say you're right. There's an argument to suggest a contradiction between professional guidelines and the law, when it comes to candour in medicine. Robert Francis recognised that and recommended a fix. Sadly, the fix we actually got was perverted by gov so as to be useless.

      1 reply 0 retweets 1 like
    7. Steven Shorrock‏ @StevenShorrock Jan 4
      Replying to @C7RKY

      ‘Fixes that fail’ - very common in social systems. https://en.m.wikipedia.org/wiki/Fixes_that_fail … It sounds to me like some protected time and space is needed to apply some restorative justice.

      1 reply 2 retweets 1 like
    8. John Clarke‏ @C7RKY Jan 4
      Replying to @StevenShorrock

      We certainly need something. Not sure that Wikipedia definition is ideal for this situation? Seems to describe a fix that starts out working, but later fails? This fix never worked - as intended.

      1 reply 0 retweets 1 like
    9. Steven Shorrock‏ @StevenShorrock Jan 4
      Replying to @C7RKY

      Problem, as with checklists, is failure in implementation. Inadequate analysis of context and how a fix affects (or does not account for) the context to create secondary problems or just embed problem further.

      2 replies 1 retweet 1 like
    10. John Clarke‏ @C7RKY Jan 4
      Replying to @StevenShorrock

      John Clarke Retweeted John Clarke

      "Problem, as with checklists, is failure in implementation" You can't imagine how close this statement is to my heart. I know this to be true. But not for the candour issue. Implementation was fine, but implemented wrong thing. This thread's worth a read:https://twitter.com/c7rky/status/937819664599670785 …

      John Clarke added,

      John Clarke @C7RKY
      #Francis called for a statutory individual duty of candour for doctors. This would make it unlawful to lie to a patient or their family We didn't get it. Instead, we were given a fudged organisational duty of candour. Here's how well that's going. > https://twitter.com/Allyncondon/status/937818531642642432 …
      1 reply 0 retweets 1 like
      John Clarke‏ @C7RKY Jan 4
      Replying to @C7RKY @StevenShorrock

      John Clarke Retweeted John Clarke

      Just in case a quirk of twitter causes you to not see it, I wouldn't want you to miss this part. This is how the law currently described a doctor's obligation to be candid:https://twitter.com/c7rky/status/937834344336457728 …

      John Clarke added,

      John Clarke @C7RKY
      Replying to @willcpowell
      "..doctors have no duty to give parents of a child who died as a result of their negligence a truthful account of the circumstances of the death, nor even to refrain from deliberately falsifying records." > Sent chills down my spine the first time I read it. Still does!
      4:13 AM - 4 Jan 2018
      • 1 Like
      • Steven Shorrock
      1 reply 0 retweets 1 like
        1. New conversation
        2. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          I wonder what was in mind to provide a safe environment for people to talk? Transport sectors have no parallel as passengers/families rarely meet professionals. Some lessons from Überlingen (aviation) and Santiago de Compostella (rail, ongoing).

          1 reply 1 retweet 0 likes
        3. John Clarke‏ @C7RKY Jan 4
          Replying to @StevenShorrock

          Wish I could tell you. I just know the medical world has thrown its full might behind resisting a statutory individual duty of candour for decades. Essentially defending a doctor's lawful right to lie to patients. Perhaps my first envious glance towards aviation now makes sense?

          1 reply 0 retweets 1 like
        4. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          I can certainly understand it. But pilots and air traffic controllers nearly never talk to pax and families (of course, fatalities very rare but when they occur, they occur in large numbers).

          1 reply 0 retweets 1 like
        5. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @StevenShorrock @C7RKY

          With Überlingen (https://en.m.wikipedia.org/wiki/Überlingen_mid-air_collision … - see 'Aftermath') there was long delay in candour and apology. With Santiago de Compostela, families do not accept responsibility placed on driver in official report (http://www.tandfonline.com/doi/full/10.1080/21665044.2015.1129889 …)

          2 replies 1 retweet 1 like
        6. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @StevenShorrock @C7RKY

          So I wonder if some clinicians' concerns are about the details of how to have these kinds of conversations (where, when, who facilitates, how, under what conditions, etc). Not excusing or advocating any point of view (have family history of harm) but curious about implementing.

          1 reply 0 retweets 1 like
        7. John Clarke‏ @C7RKY Jan 4
          Replying to @StevenShorrock

          You raise a great point, because these are indeed difficult conversations in and of themselves. Not all are well equipped to undertake them, so training there would be good. But they don't get it, because their (1 & only choice of) employer don't want them to tell the truth.

          2 replies 0 retweets 1 like
        8. Steven Shorrock‏ @StevenShorrock Jan 4
          Replying to @C7RKY

          Those are all the tricky implementation issues (assuming feasible solution) that are neglected in the hurry to 'do something'. Need full in involvement to design the 'how'.

          1 reply 1 retweet 1 like
        9. John Clarke‏ @C7RKY Jan 4
          Replying to @StevenShorrock

          You're absolutely right. We're discussing aspects of how it all needs to be designed and implemented with care, but the will to do any of it is lacking in the current environment. Vested interests with the power to enforce it, demand a different response.

          0 replies 0 retweets 1 like
        10. End of conversation

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