WHEN something goes wrong when someone is in the care of the NHS, it is only right that the patient and their family want to know why it happened and what will be done to make sure it does not happen again.
But in some cases, doctors are concerned that finding someone to blame is more important than putting in place measures to improve the health service.
When a medic finds himself involved in any kind of disciplinary proceedings - or in some cases i
n court - the Medical Protection Society (MPS) gives him the back-up he needs to get through it.
But Dr Robert Hendry – the society's head of medical services in Scotland – says the organisation's work is not just about protecting doctors, but also about protecting patients.
He said the MPS, which has just opened its first office north of the border, was keen to be involved in work to prevent errors and learn from mistakes when they are made.
"We use the word protection but I think that goes wider than protecting the doctors," Dr Hendry says. "It is also about protecting the doctor's patients."
The MPS provides professional indemnity and expert advice to doctors, dentists and health professionals around the world.
A doctor, for example, may find himself in need of help during disciplinary proceedings by their employer or if they are called before the General Medical Council (GMC) on professional misconduct charges.
Dr Hendry says the Society wants to move away from using the word "defence" in cases where doctors found themselves in trouble.
"The way defence organisations have sometimes been perceived in the past has been about getting doctors off or defending the indefensible," he explains.
"We are very much not about that. We are about promoting good and honourable practice, by helping members do that."
He adds: "I think there has been a culture shift because the days when a good lawyer could get people off have gone, because there should be proper accountability."
One concern Dr Hendry has about the way medical disciplinary proceedings are sometimes handled is that employers may set out to punish someone when something goes wrong, rather than focusing on the system that might have caused a mistake.
He says the long drawn-out process doctors could find themselves in may lead some staff to believe it was better not to report errors at all, meaning the NHS could not learn from them and improve.
"If you imagine yourself as a young doctor, you've seen one of your mates getting beaten up by the system," he says. "The patient hasn't really suffered that much and they'll never know, so why would you report it?"
Dr Hendry, who was a GP in Dundee for ten years, insists the NHS should support people who come forward, and encourage them to report mistakes to improve any system errors.
He agrees doctors do still need to be held responsible and accept that they have to be answerable when things go wrong, but this has to be done in an appropriate way.
One way to tackle problems, he explains, could be to focus on areas where teams working together in the NHS are perhaps not working as well as they should.
In these cases, Dr Hendry says they could be given special training to iron out any problems that could cause patient dissatisfaction: "If you were injured you may be able to say 'look, I think you lot need to go away and do some work on the way you and your unit do things'," he says. "That would be tremendously empowering to patients, they would feel they were being listened to.
"People want someone to acknowledge there is a problem, they want to hear how it came about and what they are going to do about it."
He adds: "It is clearly in everybody's interests that patients don't get harmed. It certainly suits the patients, but it also suits the doctors. Very few doctors or nurses set out to do harm, so when things go wrong it is a tragedy for them as well."
Dr Hendry says he has seen doctors "ruined" by something happening to a patient – in some cases when it was not their fault, and in others when a small error led to devastating consequences.
The MPS and other organisations are set to take part in a consultation looking at reforming medical compensation for patients who are harmed in Scotland.
Last week, an expert group was announced by health secretary Nicola Sturgeon to look at the issue and, in particular, whether a "no-fault" compensation scheme could be introduced.
In theory, this would speed up compensation claims and, while patients would still need to show they were harmed by NHS treatment, they would not have to prove clinical negligence was involved.
Dr Hendry believes there is certainly a need to improve the current system, which means many patients get no compensation at all due to the expensive and complex legal process. But he notes that studies showed only 17 per cent of people wanted money when they started a complaint.
"Some people need the money," he explains. "If you were blinded, for example, and could not do your work, you would genuinely need the money. There needs to be a quick redress and an appropriate redress."
He admits, however, that New Zealand's no-fault compensation system had not been perfect in making the system better: "What's tended to happen in New Zealand is that it's very expensive, because you have more people getting compensated but the amount that they get is a lot less."
And, Dr Hendry points out, New Zealand has also seen a growth in disciplinary actions because patients are not always satisfied with the way the compensation system works and the fact that it does not help improve the health system for other people.
"The doctors are not happy because they feel even more besieged by the system," he explains. "Patients are getting a bit of compensation, but not always as much as they might deserve. The organisations are not really learning from it and, if anything, there is a bit of a culture of trying to cover things up because people don't want it all to come out."
The expert group looking into the issue is due to report in October 2010, and Dr Hendry expresses hope that Scotland can come up with a better system.
"I think people who suffer avoidable harm should have rapid access to a fair system to award fair and appropriate compensation without all the hurdles in their place."
"We want to see that as part of a system that encourages openness and honesty."
