A perceived lack of openness, transparency and candour 1 has led to the enactment of the new duty of candour upon the hospitals, hospital service bodies, an organisational duty 2 and an inevitable evolving common law duty upon doctors. The justification for the statutory duty of candour arose from the alleged 'culture of fear' in hospitals. Fear is toxic to safety and improvement. Whistleblowers have been persecuted in the hospital, despite the statutory protection. 3 Their reputation, career and employment prospects have been damaged, perhaps irreparably. Doctors and administrators 'close ranks' when things go wrong and may seek to suppress or hide or cover up the unfortunate incident. Staff are 'leant on' to stay quiet. The ignorance of the patient may be exploited: 'Sorry for this unfortunate outcome, but as you will appreciate it is just one of these things that occasionally does happen in medicine.' The patient may not learn or understand what has happened. He may because of the lack of candour be denied the appropriate remedial treatment, and perhaps suffer pain or discomfort unnecessarily. Or he may accidentally find out what has happened and feel distress, distrust, anger and grievance. In cases of death, the Coroner may publicly express criticism of a failure of candour, reflecting upon the hospital and the doctors and staff. Potentially, the duty of candour should improve patient safety. When things go wrong, candour accords with the dignity of medicine and all the doctors serving medicine. Everybody experiences things going wrong sometimes, and everybody can learn and benefit from their own mistakes and the mistakes of others. Candour represents a mature attitude to the responsibilities of the profession. The patient would prefer to know the truth, however unpalatable, rather than to discover subsequently that the truth had been kept from him, and then feel justified in complaining and litigating. Justice requires candour. Sometimes the wrong treatment may have been applied-the wrong technique, the wrong drug-but no harm has resulted. In such cases, the patient may not need or want to know, or disclosure to the patient may Lawyer, Past President Medico-Legal Society, UK
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