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Who’s to blame for the current culture in the profession?

by
01 April 2017, at 12:00am

PERISCOPE continues the series of reflections on issues of current concern

THE RCVS CARRIED OUT AN ONLINE SURVEY during the first two weeks of March aimed at finding out if vets and vet nurses feel there is a blame culture within the two professions.

I can only answer for the veterinary profession, but I can say categorically that you don’t need to carry out a survey to state unequivocally that “Yes, a blame culture certainly exists.” 

Okay, I admit to having little concrete evidence to support this view, but with a considerable number of years of experience I am satisfied that the view is an accurate one. The survey also aims to find out to what extent the RCVS is to blame and I can say again, with the same degree of certainty, “to a very large extent”.

I can’t imagine that the RCVS would find this surprising. Let’s remember that the Chikosi disciplinary hearing was only a little over four years ago in January 2013 and resulted in what many in the profession considered to be a gross miscarriage of justice. That case alone was enough to strike fear into the heart of any vet who might have made what a third party (the RCVS Disciplinary Committee) could later consider to be an error of judgment. 

On the RCVS website it states: “It is a common misconception that if you make a mistake then this will be investigated by the College and you will end up in front of a Disciplinary Committee.” 

If we are taking a lead from the Evidence Based Medicine approach trumpeted by the RCVS, I’m not convinced that the word “misconception” is accurate. The Chikosi case provided clear evidence that a “mistake” would quite easily end up with the miscreant being hauled before a Disciplinary Committee and that said miscreant was quite likely to be censured or “struck off ” as a result. 

I have worked in quite a few disciplines within the veterinary field over the years and the espousing of a “learning culture” rather than a “blame culture” has frequently been trumpeted as a significant cultural shift. 

The success or otherwise of that cultural shift has eventually to be “tested” and, again in my experience, its implementation has frequently been in a manner that best suits the agenda of the organisation at any particular time or circumstance. 

Employees who have a reputation for not “toeing the party line” can often see the “no blame culture” twisted to become very much the opposite. Policies written on paper can very easily be bent and manipulated in order to ensure the outcome desired by those at the top. 

Profession awash with problems 

Of course the veterinary profession is well known to be awash with mental health and substance abuse problems. The reasons for this are numerous and varied, but the fear of being “found out” and disciplined for a genuine mistake is surely a factor because it is omnipresent, always lurking in the background like the Grim Reaper itself. 

That background nervousness leads to constant back-watching, genuine discomfort when faced with difficult decisions that have the potential to go wrong, and of course the practising of defensive medicine which is not generally in the interests of either the patient or the client. 

How does the RCVS go about tackling this? Well I guess this survey could be seen as the start of the process and if it confirms the view that I currently take as read, then it will have the documented evidence to support the need for the cultural change it says it wants. That though is only the start of the process. 

Changing a culture or mindset is not easy to achieve, especially if those responsible for bringing it about (I refuse to use the word “delivering” in this context) are those who have presided over the previous system. Because while there are many people happy to sing any tune they are told to sing by the organisation governing them, it is not always easy to erase a familiar tune from the mind; a tune (or way of working) which may have become the default position unless actively suppressed. 

Heavy-handed regulation 

I am often struck by the seemingly heavy-handed regulation of the veterinary profession in comparison to that of the medical profession where mistakes seem two-a-penny.

A study by the London School of Hygiene and Tropical Medicine reported in 2015 that about one in 28 hospital deaths (750 per month) were unnecessary and could be attributed to poor care such as inattentive monitoring, wrong diagnosis, or patients being prescribed the wrong medicine. 

That’s a fairly sobering thought, but having seen over the years the tortuous processes in place in most hospitals, it comes as no great revelation to me. Yet perhaps surprisingly, there do not appear to be scores of medics hauled every month before the disciplinary committees of their various regulatory bodies as a result of these somewhat shocking statistics. 

The medical profession is unlikely to be unique in this respect and I suspect there are plenty of avoidable deaths occurring among animals every month for similar reasons to those mentioned above. 

Clearly most vets are not being investigated when such things occur (in large part because they don’t come to light), but I am of the belief that were the RCVS to receive a complaint then they would most likely investigate the vet concerned and err on the side of the patient/client unless there was strong evidence to the contrary. 

That is what I call a blame culture and it is why most people are likely to try to play the incident down as much as they can in order to avoid possible censure.

I’m fairly certain that telling vets a new “learning culture” now exists is likely to be met with a healthy dose of scepticism until there is good evidence to support its genuine existence. Many of us would believe that holding up one’s hands and admitting to an error was tantamount to signing our own P45. 

I applaud the RCVS for seeking to find out how the professions really feel about the issues of mistakes and blame and how they are currently dealt with. However, it will take a great deal of effort and time on their behalf to persuade me that there has been sufficient change in the system to allow me to sleep easily at night on the matter.