An editorial published on bmj.com reports that better legal protection, support from regulatory groups and most importantly, a change in culture are required to promote whistleblowing in order to defend patients and clinicians.

Ten years after an anesthetist revealed preventable children´s deatsh during heart surgery at Bristol Royal Infirmary, whistleblowing is still risky, according to Peter Gooderham from Cardiff Law School. Still, the doctors’ regulatory body (the General Medical Council) demands that there is a professional ethical duty to raise concern when necessary. Without a doubt, most patients also expect doctors to protect them from possible danger.

The author explains that a National Health Service (NHS) doctor most likely has contractual obligations to join clinical governance procedures. These should incorporate systems to increasing attention and provide direction on what to do when there is improper action. However, it seems that people who call the attention to wrongdoing often sense that they are the ones considered to be the problem. For instance, the concerns expressed by the whistleblower in Bristol were “cavalierly dismissed”. Since then, his career suddenly slowed down and he was sent to work far away.

The Public Interest disclosure Act of 1998 provides some protection for whistleblowers, but many judge it insufficient. It was of no assistance to the Bristol whistleblower.

In addition, a recent investigation on the mediocre standards of care at Staffordshire General Hospital reported observations indicating that the staff were conformed to a “culture of silence”. However, Gooderham comments that such criticism “may worsen the situation by exacerbating a culture not just of silence, but of fear. Professional people may feel damned if they do raise concerns, and damned if they don’t”, he explains.

In his opinion, some new measures should be considered, such as superior statutory protection, greater support from regulatory bodies and most importantly, a change in culture in order to encourage whistleblowing.

People holding official positions should, first of all acknowledge the risks of whistleblowing. Next, they should start limiting the damages brought on by the next scandals which are most likely already happening, he concludes.

“Changing the face of whistleblowing”
Peter Gooderham, associate tutor
BMJ 2009; 338:b2090

Written by Stephanie Brunner (B.A.)