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.
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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 -
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 @C7RKYReplying 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!1 reply 0 retweets 1 like -
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).
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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?
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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).
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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 …)
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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.
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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.
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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
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.
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