I used to intensely dislike two expressions. Now it’s three. The first two – as I may have mentioned in the past – are ‘soft skills’ and ‘check-up’. There’s nothing ‘soft’ about the skills needed to survive, let alone prosper, in today’s professional arena: leadership, management, team-work, goal setting, motivational skills, all these and more are essential skills for today’s dental professional. As for ‘check-up’ I have long found that dismissive of perhaps the most vital service provided by dentists and their teams. Someone once reckoned that you could teach a student to perform an excellent cavity preparation in two weeks, and you could probably say the same for many of our high precision tasks, but consultation and diagnosis? I, for one, am still learning after 40 years.
But there’s now an addition, a highly topical one, to my list of Room 101 terms: ‘whistle-blower’. At best, it’s an expression that has become synonymous with trial by media, gagging clauses and the blame culture that sadly pervades our society.
At worst, it’s a pejorative term - an implication that a decisive and judgemental act has been undertaken. It’s not helped either, I think, by the conjured-up image of a football referee, surrounded by protesting players and being booed by about 50 per cent of the spectators.
It’s not just the terminology itself though. By the time the ‘whistle’ has been blown, the misdemeanour (or more serious chronic and systematic error) is past, the damage has been done.
I’ve seen many examples of whistleblowing in dental health care – and here we are fortunate to a degree that the damage inflicted is seldom life-threatening, let alone fatal. Some have been simply vexatious, driven by professional envy, greed or personal bias. At the other end of the scale, some are desperate and driven by a genuine inability to resolve a situation which has grown out of hand. Quite apart from the name-tag itself, there are also very practical difficulties encountered by the whistle-blower. In a profession which is largely composed of small self contained teams and not infrequently led by self-employed clinicians, to whom does one report concerns?
Many are fearful of the regulators who are seen as (and sometimes are) slow to respond, draconian and unrelenting in their processes. Seldom is the media considered appropriate. Most often, if the whistle-blower is a dental professional, it is with the indemnity organisation that the concern is raised and then often with reluctance.
When such matters are raised, a careful establishment of the facts, and an in-depth review of the ethics of the particular problem (and the individual’s motives) are called for, before, usually a cadence – or crescendo, if you prefer – of actions is recommended. Where patient safety is at risk, it may be appropriate immediately to take action, whereas in less urgent situations, there may be a number of intermediate approaches to be undertaken.
One immediate difficulty is that raising one’s head above the proverbial parapet may directly conflict ethics with employment, if it is a team member who is initiating the action. This, and the agonised debate about ‘whether’ to take action, goes to the heart of my concerns. So, two thoughts...
Firstly, the term ‘whistle-blowing’ itself (think again about the football analogy) implies that the issue has already become serious. I worry that there is still far too little emphasis, in undergraduate teaching, on the practical aspects of professionalism and ethics. In particular, in these materialistic times, too little debate on the very real dilemmas and scenarios that will, unfortunately, confront most of us during our working lives.
In the continuing (at the time of writing) tragic circumstances affecting the lost Malaysian aircraft, I am reminded that the aviation industry has spent many years, and much money, on rectifying the hierarchical mentality of flight crew. They have shown that it is possible to instil a recognition that it is ‘OK’ for a junior officer on the flight deck to question the actions of a ‘superior’; although more difficult, they have also trainedin the need for those in command to accept such questioning. In healthcare, these principles have been successfully adopted by some A&E and operating theatre teams.
I’m reminded of the statistic which showed that in 80 per cent of ‘wrong side’ surgical operations, there was at least one member of the team in the theatre at the time who had at least some doubt about the procedure – a chilling thought. That suggests one important approach – having an open culture in which matters can be addressed before any significant damage has been done.
My second wish would be that the term itself – ‘whistle-blowing’ - could be made redundant and replaced with something less tabloidfriendly and more, well, constructive. Suggestions on a postcard please.