Whistle-blowing is hot stuff right now. If it isn’t Julian Assange and WikiLeaks, it’s Edward Snowdon or Chelsea (nee Bradley) Manning. Then closer to home we’ve got issues within the NHS - the poor treatment of whistle-blowers being forced to sign gagging orders and being threatened with career ruination if they speak out. To whom do we owe our loyalty to; our patients or to each other? It depends who asks really doesn’t it? I was taught by dentists who said that you never criticise another dentist, no matter what. It isn’t just us who think this, work done with the Health Professions Council has uncovered such attitudes from paramedics as, “what happens in the ambulance stays in the ambulance”.
I sympathise with this, our jobs as healthcare professionals are hard enough without having to look over our shoulders. However, at the extreme we can see what happens when a culture of secrecy develops – just look at the Mid- Staffordshire scandal. There is definitely a culture of secrecy within healthcare, but this is seen now by regulators, politicians and the public as being unacceptable.
So what about dentistry? I can see a situation where a dentist is allowed to practice unchecked with the full knowledge their performance is poor, as being very likely. If you are an associate dentist, a hygienist or therapist or a nurse, it is likely that you wouldn’t be able to whistle blow regarding a principal dentist’s performance for several reasons. The first and most obvious reason is that it isn’t in your immediate interests to do so – the principal pays your wage after all! This is an issue that isn’t seen in hospitals as the same dependency doesn’t exist.
The other issue is that it is very likely to lead to the whistleblower facing discrimination and loss of face too. Finally, what if you’re wrong? No one wants to go out on a limb accusing another of malpractice without knowing that this is definitely the case.
Currently, the only way to whistleblow would be to a PCT (or the new replacements), the CQC or to the General Dental Council. This for many is a daunting task and may seem to be far too extreme. When you contact the GDC regarding another professional, the thought that they could lose their registration must be omnipresent. This is potentially huge; an accusation
that if proved could lead to ruining a professional’s life.
So does this mean we shouldn’t bother? My personal feeling is that the protectionist stance that was once accepted as being gospel is now defunct and actually serves as a hindrance to progress. Nobody wants to be labelled a snitch, and I imagine none but the most vindictive of complainants would want a dentist or other under-performer to lose their registration, but there is a definite need for whistle-blowing.
My suggestion is that there should be a local, informal way of whistle-blowing that is supervised by, but distinct from the GDC and other regulators so that issues might be looked at locally, in an environment where those complained about will not be referred to the GDC automatically and those who whistleblow don’t get persecuted.
I’ve had to whistle-blow before. It isn’t nice. I remember lying in bed wondering what might happen to me; whether I might somehow be in trouble too. I hope I don’t have to ever get involved in raising concerns again and so my desire for a local procedure stems from this experience.
Of course, we have all had situations where we have seen a shoddy filling and thought, “Which terrible dentist has done that?” The last time I found myself thinking this, I saw a filling that was poor and suggested we replace it but my efforts were not much better. The access was terrible and the patient was nervous and quite jumpy, so I’ve learned the hard way. Even worse is when we see poor work, look back in the notes and see our own writing! There is of course the fear that if one comments, one is then vulnerable to being commented upon. I think this is true, but then it isn’t very noble; protectionism and defensiveness are not in our patients’ interests so we should try to avoid perpetuating this.
Professionalism and our ideas of what it means to be a professional are changing. The GDC has just introduced its new standards which devotes a whole chapter to raising concerns. I do feel that the guidance is a little insensitive to the difficulties of raising concerns, for example; at 8.1.1 it states: “Your duty to raise concerns overrides any personal and professional loyalties or concerns you might have (for example, seeming disloyal or being treated differently by your colleagues or managers).”
One could argue that the GDC also sets out that practices should foster an environment where raising concerns is possible and more relaxed. The point that this raises is that the practices that do this, are the ones that are not likely to need whistleblowing. Also this fails to take into account the increasing number of practices that are run day-to-day by non-registered managers who have very little to fear from the GDC on a personal level.
The GDC doesn’t do anything but impose a duty for registrants to disclose which isn’t really good enough - employees in particular will feel incredibly hesitant to place themselves in the position of raising a concern to then find themselves the subject of colleague and employer scorn. A duty does nothing to discourage this; it can’t really if you lose out either way.
Whatever happens with regards to changing the rules of whistleblowing and the organisation of how concerns are dealt with, it is always going to take a lot of courage for potential whistleblowers to come forward. For a DCP to whistle-blow about an employer or a dentist they work with, it isn’t going to be easy and must create a lot of internal stress.
We are entering an age where the traditional lofty status of professionals which once gave them immunity from criticism no longer applies. As the pendulum inevitably swings the other way, this feeling of professional privilege is no longer appropriate and no-one is above scrutiny. I am probably unusual in my support of this. I feel strongly that for too long patients have been at the mercy of the professions and that this is no longer being accepted. We shouldn’t be surprised that the duty to disclose poor performance is becoming stronger and stronger; it has been a long time coming as patients become less happy to just accept what happens and dentistry and healthcare becomes more transparent.