- Knowledge Centre

Unconscious Bias in the nhs

Often lauded for the many wonderful things its employees do, the NHS appears to remain one of, if not the, UK’s most respected organisation.

News media regularly reports the frustrations and plight of NHS employees who are apparently ‘struggling to cope’ and ‘are working with their backs against the wall’. Many other analogues and metaphors are often used to reflect the actual and/or perceived experience of NHS employees.

But one aspect of the NHS as an organisation, and its employees which is rarely reported, unless so sickening that it involves loss of life due to either incompetence or sickening absence of attention to the facts of a patient’s condition, the very real failures of the NHS as an organisation and failures of some of its trusted technicians, from the most senior doctors to the most junior nurses, are difficult to raise in a formal environment.

One such situation is that of a man who 11 years ago who whilst bed-ridden in hospital was ‘diagnosed’ with a psychiatric condition which was causing severe and apparently unbearable pain in his spine. During a period of 4 days, even heavy doses of morphine and other medication failed to alleviate the pain. A pain which one doctor, and then a second, stated didn’t actually exist!

On day 5, the gentleman, whose emaciated body had appeared due to his inability to actually move more than 2 steps before having to stop due to the searing pain which he said shot from the top to the bottom of his spine, was recommended for being discharged from hospital.

The patient’s brother declined to discharge and politely (and assertively) asked for a spinal specialist to attend to make a diagnosis. Less than 30 minutes following this request, a second doctor attended with the doctor who had recommended discharge. Yes, the second doctor agreed with his colleague that the patient should be discharged and referred to a psychiatrist for ‘treatment’.

Again, discharge was declined with another, more assertive demand that a spinal specialist visit and examine the patient…or else the Trust’s CEO would be approached with this demand. 4 hours later, a spinal specialist attended, examined the patient, recommended a specific spinal scan (2 scans of some kind had already been undertaken with apparently no indication of spinal damage). Within 6 hours of this spinal specialist recommending the specific scan, the results were received. The result?

The scan had identified that the patient’s spine had experienced 4 vertebrae that had begun to crumble. Fragments of the spinal bone was now resting on the patient’s spinal chord. This is the reason that morphine was not able to ease or remove the ACTUAL pain the patient had been and continued to experience. What happened next?

The two doctors who had supposedly diagnosed a psychiatric issue were nowhere to be found after this finding. No apology was received and no accountability was taken. The patient was transferred to Leeds Infirmary to undergo what was to be a gruelling 9 hours of spinal surgery which ultimately saved his life, and took 6 months for the patient to recover from. An apparent ‘superbug’ had infected the patient and he would need to take medication for the remainder of his life to reduce the risk of it returning – as it couldnt be eradicated completely.

Move on 11 years…

Once again, senior members of medical staff including the patient’s GP, who has access to the patient’s full medical history, and hospital medical practitioners who also have access to the patient’s full medical history, have done it again. Misdiagnosed, refused to release their ego’s from their ‘expert opinions’ that the patient is worth listening to.

Once again, the superbug has returned and is eating away at his body with great appetite. His GP gave the patient painkillers. They didn’t work. The hospital referred the patient back to his GP, with painkillers, and no medical professional has taken responsibility for their trusting patient’s welfare of health.

Even when the patient was taken to hospital by Ambulance, and placed in a wheelchair as he was unable to stand, and unable to straighten his spine due to the searing pain which had returned, asking a nurse for the use of a ‘seat belt’ of some kind to secure him in wheelchair is met with “We can’t allow you to use restraints with a patient as that is a breach of their human rights.”

OK, what has this got to do with anything? Quite a lot actually.

The doctor who then undertakes the initial patient assessment then feels it appropriate and helpful to ask the somewhat delirious patient “So, how many of these holes in your arms have you done yourself then?” What a condescending, inappropriate and ego driven question. A question that best serves the ‘expert’ than the patient perhaps? My response of “None of them actually doctor. Your colleagues did them” caused the doctor some discomfort as his comment of “Oh I was only asking” was partnered with a blushing face and look of fear on his face.

  • Experts are often deemed as the font of all knowledge. Really, they are not. Their decisions can be as fundamentally flawed as the rest of us.

  • Compliance with an authority figure is dangerous. Failing to ask prudent questions, and challenge generalisations, and opinions – which can appear as ‘facts’ can cause personal and collective damage which cannot be recovered from.

  • Unconscious Bias and even prejudice exists. People judge people, situations and encounters, and that’s understandable. When though these actions risk a human being losing their life, a family losing a loved one, personal ownership of decisions, recommendations and actions deserves to be taken.

  • The patient is my brother, Stuart. He is currently fighting for his life and is likely to be a hospital resident for at least 3 months. His superbug has also cause a hole in his oesophagus to be created. Nil by mouth, not even drinking water. Just sucking lollies dipped in water.

When will be the right time to hold the NHS and its Officers accountable for the fundamentally flawed decisions they make, which cause harm, and hold them to a higher standard? Remember, a ‘medical opinion’ may be completely different to a ‘medical fact’.

Find out more about Unconscious Bias Training or call us on 0845 052 3701

The specific outcomes I set for the project were delivered much more quickly than I anticipated.
P Gilroy
 - Head of Community Support Services, Denbighshire County Council