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Raj Persaud in conversation - the podcasts

Sep 3, 2014

Headstarters Part 8! Raj Persaud in conversation with young psychiatrists

Medical students seem to be put off choosing psychiatry as a career by their psychiatric attachment during medical school. Why is this and can anything be done about it? Raj Persaud Consultant Psychiatrist in Private Practice in Harley Street discusses the predicament with young psychiatrists in training.


 A related article from The Huffington Post which may be of interest:


Sir David Nicholson Resigns but if Many Bad Apples Remain, The NHS Might Be Rotten to the Core


Raj Persaud and Peter Bruggen


Sir David Nicholson, head of the health authority that oversaw the Mid Staffordshire NHS Trust hospital for 10 months in 2005 and 2006, before becoming the head of the NHS in England, told a committee of MPs a couple of months ago, that he was "absolutely determined" to carry on leading the NHS. 


Before his appearance at the committee, he was reported to enjoy the support of Downing Street, but afterwards, it was said, such backing was on the wane. Now he has resigned, he's been quoted as admitting that the health service "can still sometimes fail patients, their families and carers".


It seems that you can oversee the unnecessary deaths and suffering of hundreds of patients yet be promoted in the NHS. However, should you embarrass the Prime Minister's office, before a parliamentary committee, then you're in real trouble. 


Charlotte Leslie, the Tory MP for Bristol North West, is quoted in the Daily Telegraph as being "absolutely sickened" that Sir David has been able to retire on his own terms. She is quoted as declaring:

"While whistle-blowers who raised serious concerns about patient safety were sacked, and had their careers ruined, a man who mislead Select Committees, did not intervene as promised in whistle-blowing cases, who implied those raising concerns about mid-staffs were simply 'lobbying' and who presided over the culture of fear and bulling in the NHS, walks away with a large public sector pension."


But scandals can get things going.


Professor Mary Dixon-Woods, Karen Yeung and Charles Bosk recently reviewed examples of scandals around the negligence of doctors from the mid-Nineties onwards, where they appear to have had particular impact: tougher regulation of the medical profession. 


In their paper entitled, 'Why is UK medicine no longer a self-regulating profession? The role of scandals involving "bad apple" doctors', the academics from the University of Leicester, King's College London and the University of Pennsylvania list examples of recent outrages which galvanised medical regulation. 


Professor Dixon-Woods and colleagues suggest in their study published in the academic journal 'Social Science and Medicine' that in part the power of scandals derives from the intensity around their reporting. Vivid, emotional rhetoric, provokes public alarm. They argue that to some extent the extreme nature of the transgressions, the innocence and dependency of the victims and the chasm between claims of virtue of the offenders and their actions, create momentum for change.


Dangerous doctors appear to be a threat. Antagonistic Chief Executives and NHS bureaucrats do not appear as dangerous, although administrators might be more hazardous than individual clinicians. 


Historically faceless bureaucracies have killed many more individuals than even the most dangerous doctor, but it's the 'bad apple' physician who seems most capture the public imagination. But does this distract those who should be paying more attention, allowing a 'Mid-Staffordshire' crisis to occur under their noses? 


The Royal Colleges have been mysteriously quiet about NHS scandals, seeming blind to them until they erupt into the press, along with the GMC, Monitor, Care Quality Commission, Health Care Commission and the Nursing and Midwifery Council. The preoccupation on what went wrong at Mid-Staffordshire, as exemplified by the questions Sir David faced in parliament, has side-tracked commentators from asking a more fundamental question, namely where was everyone else? Where were the GMC and the Royal Colleges? They were meant to be upholding standards as well.



Doctors are now surely one of the most regulated professions in the UK?



Bodies like these are often not as independent as they would like to be seen. They all may have become too dependent on government discretion and support. There seem to be many ways in which senior clinicians move over 'to the other side', appearing keen to court the ear of the 'establishment'. They don't rock the boat as much as their primary allegiance to patient and medical science should provoke them to.



If the public cannot rely on the host of regulators all of whom failed, then patients and the population of the UK are going to have to become a key part of future regulation, perhaps just as lay members now play a much greater role at the GMC, following the scandals of the 1990s. This means taking much more interest in their NHS, looking after it, protecting the good doctors and nurses they find there. 


The public will have to question their local trusts and other health care organisations, using the Freedom of Information Act if necessary. Lobbying whenever experiencing an example of good care, as well as bad, means trust will be restored in the system because of confidence in regulation by patient. 


Doctors are going to have to be much more honest with patients when the care being provided is sub-standard medically, particularly if they are administrative and bureaucratic reasons.



Recent events reveal we can't complacently leave the NHS in the hands of the bureaucrats and the politicians. Our experience is they have created a culture of fear and bullying whereby good clinicians are persecuted for standing up for patients or medical science. We have seen officials who endeavoured to discourage whistle-blowing promoted and, at very worse, paid off handsomely.



There has been little interest shown by regulators in pursuing those in management who colluded with gagging clauses in clinician's leaving agreements - emblematic of the culture of bullying in the NHS - stopping doctors speaking out about poor care. These agreements are now supposed to be illegal - but what is being done about those who implemented them, and who are still in post in senior positions in the NHS?



We therefore need to re-centre the whole organisation around the sacredness of the encounter between clinician and patient.



Because, the failure to root out the true rotten core at the heart of the NHS, means more scandals will inevitably follow, even after this latest resignation.





Raj Persaud


Dr Raj Persaud is a Consultant Psychiatrist who has worked as a
Consultant at the Bethlem Royal and Maudsley NHS Hospitals in London
from 1994-2008, and as an Honorary Senior Lecturer at the Institute of
Psychiatry, University of London. These are the premiere research and
training institutions for Psychiatry in Europe.



He was also Research Fellow at Johns Hopkins Hospital in the USA
and Institute of Neurology at Queens Square. His training in psychiatry
since leaving UCH medical school in1986 was entirely at the
Institute of Psychiatry and the Bethlem Royal and Maudsley Hospitals.



Unusually for a psychiatrist, he also holds a degree in psychology,
obtained with First Class Honours, and 8 other degrees and diplomas
including a Masters in Statistics.  He was awarded the Royal College
of Psychiatrists’ Research Prize and Medal as well as The Maudsley
Hospital's own Denis Hill Prize, and The Osler Medal.  The Royal
College of Psychiatrists' recently also awarded him the Morris Markowe



In 2004 he was appointed Visiting Professor for Public Understanding
of Psychiatry at Gresham College, and he was asked by the Royal
College of Psychiatrists to edit its first book aimed at educating the
public on psychology and psychiatry.  'The Mind:  A Users Guide’ was
published in 2007 and reached the top ten best-seller list. All of his 5
previous books have been top ten  best-sellers.



His writing is in several established textbooks, including the Oxford
Companion to the Mind and he has contributed a chapter in the latest
comprehensive textbook of psychiatry for trainees: Psychiatry – An
Evidence Based Text. He has approaching 100 publications in Journals
such as The British Journal of Psychiatry, British Medical Journal and
The  Lancet.



Recently he was elected Fellow of University College London and the
Royal College of Psychiatrists.  He is patron or supporter of numerous
mental health charities including OCD-UK, The Manic Depression
Fellowship, Association of Post-Natal Illness, Childline, Action
Aid and The Samaritans.



The Independent on Sunday Newspaper conducted a
poll amongst members of the Royal College of Psychiatrists and the
Institute of Psychiatry to discover who were the top ten psychiatrists
in the UK as rated by fellow psychiatrists. Dr Raj Persaud was the
youngest doctor to make it into this esteemed list. The Times Newspaper 
also  recently placed him as one of the Top Twenty
Mental Health Gurus in the world.