Whistleblowing: Tuning In
Would you ever blow the whistle? Elizabeth Leyland explains more about this potentially career wrecking activity
From childish taunting in the playground to kiss-and-tell exposés, whistleblowing affects everybody at some stage of their lives. It raises awareness of ‘naughty’ behaviour, but is almost invariably damaging and very difficult to reverse. In healthcare there are particularly high stakes: lives, jobs and money are potentially at risk if inappropriate practice goes unchecked. If whistleblowing is used too freely the repercussions can be especially severe. I want to tune in to some of the difficulties associated with whistleblowing in a healthcare setting. With these in mind, I will consider the balance between moral responsibility and personal cost of ‘whistling while you work’.
According to the Collins English Dictionary, to ‘blow the whistle’ is “to inform (on)” or “to bring a stop (to)” (1). In practice, whistleblowing is more precisely understood to mean “informing on illegal and unethical practices in the work-place” (2) or “to raise a workplace concern in the public interest.” (3)
Healthcare is “an emotionally charged part of the economy and society.” (4) For most large companies the biggest threat is financial ruin, but in healthcare life and death hang in the balance. Errors can lead to morbidity and mortality. Eliminating such errors, potentially through whistleblowing, is consequently both more important and more daunting. Discretion is important for many businesses, but in healthcare there is a shroud of confidentiality surrounding everything and everyone. This places additional pressure on whistleblowers, by making it more difficult to recognise, investigate and report malpractice.
In the UK, the National Institute for Clinical Excellence has released a ‘Policy and procedure for the disclosure of information in the public interest’ stating that “It is the duty of every member of staff to speak up about genuine concerns”. (5) If such policies are taken advantage of, they offer an important mechanism for maintaining healthcare standards and enhancing patient care. The General Medical Council reinforces the need to “protect patients even if this means reporting a colleague or refusing to give a reference.” (6) here is clearly a legal and moral responsibility to blow the whistle, but at what cost?
The reputation of a whole hospital can be damaged by an incident involving one department, or even one individual. Patient care can be dramatically adversely affected by the sudden removal of a doctor, particularly if they are the only specialist in a certain field. Important working relationships are almost invariably destroyed by allegations, suspensions and dismissals. Once lost, they are extremely difficult to rebuild. If a radiologist does not have much confidence in a surgeon, so blows the whistle, the friction within the remainder of the group can cause the multi-disciplinary healthcare team to collapse. The other surgeons might breathe a sigh of relief that somebody else has spoken out, but on the other hand they might feel that they perform in a very similar manner and start ‘watching their backs’.
Medicine has traditionally centred around a culture of loyalty, one in which you shouldn’t ‘let the side down’. Dr Stephen Bolsin was a Consultant Anaesthestist at the Bristol Royal Infirmary who blew the whistle on high mortality rates among babies having heart operations. After initially receiving a “dismissive” telephone call, he was “called to the office of James Wisheart”, the medical director and a senior heart surgeon. According to Stephen Bolsin, “He made it quite clear to me this was not the way I should carry on. This was not the way to progress my career in Bristol.” (7)
Whistleblowing can leave the ‘tale teller’ open to victimisation, suspension or dismissal. Suspension has huge implications, far beyond the obvious prohibition from work for a certain period of time. Dr Jane Marshall, a consultant psychiatrist explained that “Very often, these doctors have been conscientious perfectionists…Once a doctor has been suspended they are not supposed to go near their hospital. They feel ostracised…their friends are their colleagues.” Out of a group of over 100 suspended doctors, “more than 80% had been totally exonerated” (8), yet sadly, UK National Audit Office figures from 2003 show that just 40% of excluded doctors returned to work. The small number who do “are de-skilled, demoralised and can have mental health problems.” (9) The damage caused by the “typical organisational response” to whistleblowing “causes severe and longlasting health, financial and personal problems for whistleblowers and their families.” (10)
The impact of whistleblowing spreads far beyond the working environment of those directly involved. A study into the effects of whistleblowing on individual whistleblowers found that in 7 of the 35 cases examined long term relationships broke up. There were 77 children of subjects and 60 of them “were adversely affected.” (10) The family of a whistleblower who is dismissed, vilified by the media and unable to find employment is severely disrupted by something that they have had no say in whatsoever. Although the ‘Bristol Babies Inquiry’ that followed Stephen Bolsin’s claims exposed unacceptable mortality rates, he and his family were uprooted to Australia. He claims that he was “shunned by the medical establishment and forced to seek a job abroad after applying unsuccessfully for posts in Britain.” (7)
Whistleblowing is usually not a pleasant activity. It is far harder to do than remaining silent, because it is an active process. Causing harm is not easy for most people, even if it is in the pursuit of good. The relative impact on the whistleblower and the accused must be considered, bearing in mind the domino effect on families, colleagues and patients of both. Ultimately, the question is one of doing good versus doing no harm. The risks involved in remaining silent must be balanced against the damage done by speaking up.
Whistleblowing should not be undertaken lightly, hastily or for the wrong reasons. If carefully considered and carried out ‘in tune’ with recommended procedures, it is a vital mechanism for maintaining standards in healthcare. Despite the potential personal cost, there is a moral responsibility to highlight genuine concerns by blowing the whistle.
Elizabeth Leyland
Fourth Year medical student
University of Leeds, UK
lizleyland@hotmail.com
(1) Collins English Dictionary. Anderson S. Italy, HarperCollins Publishers 2005
(2) Vinten G. Whistleblowing: subversion or corporate citizenship?, Whistleblowing - fact and fiction. An introductory discussion. London, Paul Chapman Publishing Ltd 1994
(3) Hunt G. Whistleblowing in the Health Service, Introduction. London, Edward Arnold 1995
(4) Berwick DM. Improvement, trust, and the healthcare workforce. Qual Saf Health Care 2003; 12:448-452
(5) Dillon A. National Institute for Clinical Excellence, Policy and procedure for the disclosure of information in the public interest (Whistle blowing in the NHS). January 2006
(6) Dyer C. Consultant found guilty of failing to act on colleague. BMJ 1994; 308:809
(7) Dyer C. Whistleblower in Bristol case says funding was put before patients. BMJ 1999;319:1387
(8) Anon. Whistleblowing or professional assassination. BMJ 1998; 316:1756
(9) Pritchard L, Clews G. Hung out to Dry? BMA News 03/06/06
(10) Lennane KJ. “Whistleblowing”: a health issue. BMJ 1993; 307:667-70
Bookmark on delicious | Digg