I made a mistake at work today. We all do it. But what if I said that I was a doctor? When a plumber gets it badly wrong, he leaves you with a flooded kitchen; when a doctor gets it badly wrong, he leaves you dead or crippled for life. One in every 10 hospital patients is harmed by a medical error. As many as 70,000 people die every year as a result of doctors' mistakes.
While I was a medical student, I saw a young guy with a bad knee. After the patient left, the consultant explained that the surgeon who had carried out the operation had got it badly wrong, and this was the cause of the patient's disability. He would never walk properly again. I asked the consultant why no one had informed the patient. He answered that you don't blow the whistle on colleagues and they don't on you. I thought that he was wrong, that the patient had a right to know the truth so he could fight for compensation and that the doctor should be held accountable for his negligence.
When I qualified, I soon learned that there would be times when I would be called upon to conduct procedures I had never seen, let alone practised. Airline pilots learn to fly the plane before they have to carry passengers. Due to limited training opportunities, doctors gain experience by treating patients. We are carrying passengers before we know how to fly the plane. Even newly qualified consultants are under-trained: an average of 8,000 hours' experience, in contrast to the previous generation who gained 30,000. We all kill a few patients while we're learning.
I was responsible for a few cock-ups in my early days as a new houseman - a tardy diagnosis, a wrong infusion, some patients with bruised arms from clumsy attempts to take blood or insert an IV line - but they were mended by a sincere apology to the patient and an ad hoc tutorial from a senior colleague. It was a month before one of us made a contribution to the hospital's mortality rate. A close friend had been instructed by his consultant to monitor a particular patient's potassium level, but my friend's shift got wildly busy and he put it off. The patient suffered a cardiac arrest and died.
He confessed the truth to a couple of us that night, but to his consultant he claimed that he had carried out a potassium test but that the result had got lost in the system. He felt awful about the patient's death but he could see no way of being open about his mistake without his consultant deciding that he was irredeemably incompetent.
He trusted his fellow housemen with the truth, but he didn't know his consultant well enough to be sure he wouldn't blow the whistle. I think this was the moment I realised that not every doctor who makes a mistake is a bad doctor. I knew my friend was good at his job. He had made an appalling but uncharacteristic error of judgment. Two years earlier, I had been the moralistic medical student in an orthopaedics clinic outraged by the covering-up of a young man's botched knee surgery, and now I was a doctor who understood how many critical decisions cram the working day and how easy it is for a tragedy to unfold from a momentary lapse in concentration.
On closer examination, the cases I have cited from first-hand experience don't reflect the errors of a single individual. The surgeon wasn't the only person involved in the care of the young man with the wrecked knee; my mate wasn't the only person looking after the potassium patient. Nearly all medical accidents result from a chain of errors involving the misjudgments of a series of practitioners.
The systemic failures with respect to training, supervision, communication and cross-checking are more far-reaching than the malpractice of an individual. However, many people find it less disturbing to believe that medical accidents are due to the negligence of a lone gunman - the individual acting alone and counter both to his training and to the expectations of his colleagues. Furthermore, the people harmed by medical accidents are eager - if they aren't, their lawyers are - to prove negligence, because if they don't, they don't secure any damages. There are other factors, but I believe these two are the highest-octane fuel for the blame culture.
The punishments for getting it wrong are only getting harsher. Recently, the courts levelled a charge of manslaughter against a doctor who injected a drug wrongly. The same mistake had occurred at least a dozen times before in other hospitals and by other doctors, all precipitated by administrative blunders and a lack of safeguards. The system lay at fault, not just the individual. Yet, for one momentary lapse of judgement while carrying out his normal duties, a respected professional who has dedicated his life to treating the sick can find himself facing the same legal proceedings as a knowingly drunk driver who mows down a pedestrian or a construction manager who with calculation flouts safety rules to maximise his profits.
Yet when things go wrong, many doctors still feel compelled to admit their failings. You hope a sincere disclosure will serve as an apology to the patient and also stop other doctors making the same mistake in future.
I was part of a chain of errors that led to the death of a patient. I believed my error was the most harmful one - more harmful than the nurses saying the patient was faking her symptoms, more harmful than the senior doctor who saw the patient the next day and agreed that we shouldn't do an x-ray or blood tests - and I confessed it to my consultant.
I was overcome with remorse. I wanted to apologise to the relatives and stand up at the inquest and say it was all my fault and I deserved to be struck off. He counselled me to brazen it out. Another colleague helped me buff the notes (to "buff the notes" is to make entries in the patient's records which don't actually lie but contain only the helpful elements of the truth). I still feel huge remorse both for the mistake and for never apologising to the relatives, but, instead of my career faltering before it had really begun, I learned from it, became a better doctor because of it, passed on what I had learned about it to many other colleagues, and I was only able to do those things because my fellow doctors covered for me.
A couple of years on, I was called to a surgical patient with an abnormal heart rhythm. A cursory examination of his notes revealed an ECG which showed that he had suffered a heart attack, but the houseman who had admitted him had missed the diagnosis. After we had stabilised the patient, I showed the ECG to the admitting houseman's registrar. The registrar was a mate; he was one of us; I could trust him. We agreed that he would pretend he had come across the ECG himself when reviewing the case. He would talk his junior through the lessons to be learned from the incident. The houseman would never know anyone else was aware of his error. Not for a moment did I have second thoughts about this course of action. The system had protected me and I owed a fellow doctor the same obligation.
Some doctors feel compelled to blow the whistle on their colleagues' shortcomings. The medical profession invariably ostracises those who broadcast their concerns to outsiders, on the grounds that outsiders don't know enough about the job to fairly judge a doctor's performance. In my writing, I have chosen to concentrate on the darker side of hospital life. You might argue that I have acted like a sort of whistle-blower, but I feel that I have endeavoured to acquaint the lay person with the factors that contribute to medical error and, hopefully, the actions of doctors who close and cover will appear more understandable.
Turning a blind eye and closing ranks serves well all of us who made the isolated human error and learned from it and became good doctors. I believe that is how it served me and my friend who didn't monitor his patient's potassium. But I have to confess I don't know what kind of doctor the houseman who missed the heart attack became. It is only then that you realise the system that covered for you is the same system that wrongly protected GP Harold Shipman and gynaecologist Rodney Ledward for so many years at so tragic a cost to so many patients. But, because of the blame culture, many doctors remain persuaded that closing ranks and covering up are in their interests, because they still fear that they can be as much victims of medical accidents as their patients.
· Jed Mercurio was a hospital doctor for four years before becoming a full-time writer. He wrote the successful TV series Cardiac Arrest and his new drama, Bodies, starts on Sunday at 9pm on BBC3. It will be screened on BBC2 later this year. His novel, on which it is based, is published by Vintage.
