Revealing, honesty and openness

I have just now read an article in the online Guardian about Dr Wendy Potts, a Derbyshire GP who documented her experiences of living with bipolar disorder in a blog; following a complaint to the GMC by a patient, she was suspended from practice for over three months, this possibly led to a deterioration in her symptoms which has been linked with her suicide.

I do not know the details relating to Wendy’s blog nor her psychological state, home situation or her death.

I am specifically worried about openness. Openness in relation to doctors – and probably anyone working in the health and social care sectors.

In April this year a junior doctor was held to account following the publication in court of their private reflections of practice. This is something doctors are encouraged to do – reflect; look back on what we have done, review and analyse what went well, what could have gone better, what we need to learn and so on.

Many of us reflect all of the time in conversations with our colleagues, family and friends; actually documenting your thoughts whether on paper or online is considered to involve a deeper level of analysis, it also leaves a permanent record which can be helpful – say, when a year or two later you look back; in the case of the junior doctor above, this detail, where they admitted privately their inadequacies, was used against them in court.

A more specific example of this might be when I undertake a task, say, taking blood – I might be successful – take the sample, cause the patient no pain and move on; I might, if I am a beginner, struggle, it might take me several attempts, it might cause the patient upset or discomfort, this is natural for all skills humans practice – we start off learning (called unconscious incompetence by Jo-Hari) and progress through the steps towards unconscious competence.

Reflection is an inherent part of this, and reflecting openly and honestly is surely a fundamental.

Following the case with the junior doctor who reflected on their conscious incompetence (i.e. their awareness of not having mastery), there was much discussion within healthcare as to whether this information should be public, and, the risks doctors and nurses expose themselves to in documenting their incompetence in private, particularly online documents (we know in the post-Snowden era that nothing online is entirely private).

Suggestions were made that doctors tone-down their language – perhaps instead of saying that they were incompetent or poor at a skill, write, ‘need to improve,’ or, ‘must do better’ – a sort of Orwellian political correctness that threatens freedom of speech.

And back to Wendy, who dared to share. Who was open about her mental health condition and for whom it backfired.

Clearly blogs are a step away from private reflections in our professional diaries and likely we should be and are freer to be more open in them than we might when publishing to the world, yet, the tragedy inherent in Wendy’s case, and doubtless others where doctors, nurses, social workers and therapists have crossed the line between private and personal, open and closed, what can and should not be shared, is that only when we can all be open with the world, overcome our egos and biases, acknowledge one another’s fears, anxieties, preoccupations and inadequacies can we hope to improve, to grow.

Thank goodness for those who push the boundaries, who are open and transparent, showing the world that we aren’t infallible, perfect beings. That we are all human.