As NHSreality has pointed out from the beginning, there are Perverse Incentives in all aspects of medicine. The hidden action(s) (such as smoking) by the patient, and the hidden information (such as better tests or treatments elsewhere) always have potential to distort the doctor-patient relationship. Many doctors, especially altruistic juniors feel gagged, and in Wales, without choice, the penalties for staying in your own local DGH are not clear, as patients cannot get meaningful comparisons.. and certainly not comparisons with England.
Only one in five doctors says they can always act in their patients’ best interests, according to a study that calls for a renewed focus on morality in medicine.
Doctors have succumbed to a “culture of compliance”, the experts say, and reasserting the importance of virtue and character could help to prevent more scandals over poor healthcare, such as the one at Stafford hospital.
More than 90 per cent of doctors say their job makes it hard to treat patients in a way they believe is right, or involves tasks that conflict with their moral values, a survey of 550 doctors and medical students found.
Kristján Kristjánsson, deputy director of the Jubilee Centre for Character and Virtues at the University of Birmingham, said that too many professionals were “embarrassed” about moral questions and patient care suffered as a result.
He said he wants virtuous thinking to be included in doctors’ training to help them to overcome a “tickbox” mentality that puts following processes above doing the right thing.
“We want to try to replace a culture of compliance with a culture of moral wisdom. Rules are fine as far as they go but you have to see across the board.
The obvious response to a scandal like Mid Staffs is just to write more rules, but that can be counterproductive in that you replace an internal motivation to act well with an external motivation based on sanctions.”
Doctors at Stafford Hospital failed to protest as patients were neglected to meet financial targets.
Professor Kristjánsson said that such problems were made more likely by ignoring moral questions. “It’s so easy just to follow the rule book and go through the motions, “ he said.
“We think [moral training] is one way that you can forestall further scandals of that kind. By following these recommendations it is more likely that medical professionals have a firm ethical ground to stand on.”
Mark Porter, chairman of the British Medical Association’s council, said the problem was overwork rather than moral fibre. “Graduates leave medical school enthusiastic and determined but, over time, rising workloads, insufficient resources and a target-obsessed culture leave many feeling frustrated, exhausted and unable to deliver the quality of care they want to for their patients.”