Steve Turner: Nurse and medical educator: ”Arrogance is a medical error”

Nurse and medical educator Steve Turner talks about the medical errors he’s witnessed - and participated in - and how being a health care whistleblower is likely to get you fired from your job and blacklisted from future opportunities.

Steve also talks about the tragic and needless death of Oliver McGowan who was killed by multiple health care workers who failed to listen to him. Steve also shares how the paternalistic physician culture has baked-in arrogance, and that in and of itself, is a medical error.

Mental Health Nurse

0:05:00

Steve grew up in Stafford, England - a happy childhood, with one brother - moved to Rugby when he was 17 and he had been doing poorly at school but then started to think about his future - Steve did not know what he wanted to do, but because his friend's father was a psychiatrist, and Steve grandfather had mental health issues, he was drawn to that field - but worked in a restaurant in Coventry and met some Australians working there

0:07:00

Steve then moved to Shepparton, Australia on a work holiday - Steve had a wonderful experience, working in bars, fruit picking and other casual labour - Australia was booming while the UK experienced 'the winter of discontent' - that 10 years traveling and working in Australia provided more experience to draw on than any training course - have to rely on your wits, meet a variety of people - when he later became a mental health nurse, he'd already come across mental health issues from his experiences

0:09:00

Steve always thought he wanted to do nursing, had realized he couldn't be a casual, traveling worker forever - he was accepted by St Georges in London, UK - Steve did general nursing followed by specialty in mental health nursing - drawn to it in part because his grandfather spent his life in a mental hospital and died there

0:11:00

Steve was attracted to the physical and mental health of a person, to look after the whole person - when Steve first started, he worked in a large acute ward with 40 beds - it wasn't a kind environment, but the people he worked with were good - Steve was interested in community mental health, and there were a few teams at that time - when Steve returned to nursing in 2002, he recognized how much things had changed

0:13:00

After nursing for a few years, Steve started to work for US company SMS in the UK - they provided IT services to health care and Steve thought he'd work for them for 6 months but stayed to 10 years working on clinical systems and became a senior consultant - working on 'clinical systems' meant he spent a lot of time on wards and with doctors - Steve also specialized in clinical governance showing the clinical credibility of the system

0:14:45

Steve tweets and talks about medical errors a lot - the 1980s things were different, a lot of shocking things - Steve worked on a ward where one doctor would not tell cancer patients they had cancer, something that wouldn't happen now - Steve has seen medical errors happen and 1 doctor say another is responsible, but nothing came of it - there was no structure to deal with it - doctors and nurses were a law unto themselves

 

 

Arrogance and Paternalism

 

0:15:30

A recent case in the UK where a doctor didn't tell a patient a cancer diagnosis and that has hit the headlines - Steve thinks it is arrogance - but often patients would ask nurses for the truth and would be told - the kindest way to describe doctors holding back a diagnosis is paternalism, "I'm the doctor, your the patient, I know what's best for you' - still common unfortunately

0:17:00

After 10 years in IT, Steve returned to nursing in 2002 - worked for local 'assertive outreach team' to work with people who have been labeled 'hard to engage' but Steve said its the services that are hard to engage - working with people that are marginalized, they had more freedom to try different approaches and had a lighter case load

0:18:30

Steve worked with people who took street drugs - his approach was to include their drug use in their recovery plan - they would try to find what worked with each person - Steve had seen a lot of meds given to people to sedate them - sometimes meds just made people look like they were better to the clinicians, but they actually felt terrible

0:20:00

Steve would ask his clients 'what would help?' - Steve had to build trusting relationships - he spent 3 months talking through a door crack before one client let him in - one client told Steve he appreciated being treated like an ordinary person, this was the best compliment Steve received

0:21:45

Sedating patients and giving information are both medical error, and can lead to harm - there's a lot of research showing antipsychotics and how they make patients look like they're better, but they're not - arrogance is a medical error - for mental health, health care workers can persuade people to do things that are wrong for them

0:23:00

In the UK, the mental health act, to lock someone away, a mental health assessment is undertaken and different people do the assessment and recommendation - there is a big legal process, it doesn't always work well and some people have been 'sectioned' (locked away against their will) when they shouldn't be - Steve has seen people sectioned inappropriately

0:24:00

Steve thinks one person was sectioned because he was Spanish - this person had an English accent but was raised in Spain and had Spanish expressiveness, and that is why he was sectioned - on the other hand, Steve has seen some really ill people who initiated a mental health assessment, and he was very worried they would not be sectioned because they were such a risk to themselves

 

 

Oliver's Campaign

 

0:26:00

Steve is starting to learn more about the shocking situations where the parent, usually mother, is accused of 'fabricating or inducing illness' on their ill child - also called 'Munchausen by Proxy' - in children with ME (myalgic encephalomyelitis) / chronic fatigue syndrome, the blame shifts to the parents and that happens a lot - Steve has worked in situations where the mother is ignored and labeled as 'difficult'

0:27:15

The case of Oliver McGowan, he had mild autism and a learning disability - the state thinking it knows better than the parents is a huge issue in the UK - Oliver was 18 years old and died 2 years ago in hospital - he occasionally had seizures, and would be a bit agitated as he came out of it - they were investigating his seizures - he had been mistakenly sectioned

0:28:30

2 years ago he had a seizure and was admitted to hospital and was ventilated so they could do a brain scan - in the past, Oliver had been given antipsychotic meds and he always had an adverse reaction to them - at one point he had a dystonic reaction - an oculargyric crisis (reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes) - extremely frightening as your eyes roll back and you can't move

0:29:00

Other antipsychotic meds made Oliver feel like there were flies buzzing around in his head - Oliver was never psychotic - Oliver had a care plan that said not to give him antipsychotics - in the ambulance on the way to hospital he said 'please don't give me antipsychotics' - Oliver told staff again at the hospital and it was written on his drug chart in red ink

0:30:00

But he was given antipsychotics and died from neuroleptic malignancy syndrome, a rare but fatal reaction to antipsychotics - his mother Paula has campaigned for training in hospitals for all staff on disabilities and autism - just started rolling out Oliver's Campaign is hashtag (#OliversCampaign)

0:31:30

Doctors are duty bound to take the patients best interest decision by taking everyone's views into consideration and document it, but that wasn't done

0:32:30

Steve had a whistleblower experience - it is not just a hospital problem, it is society wide - when Steve left the NHS in 2006 he had some recommendations - the team he worked for was being disbanded, yet produced good service - Steve wrote a letter using the formal grievance procedure - but Steve deliberately copied the letter to one of the general practitioners the team worked with very closely

0:33:30

Steve was suspended - Steve thought, 'if you try to change things with a reasonable letter, and then you get suspended for 6 weeks' - he didn't want to work for that kind of organization - Steve became an independent consultant and got hired back by the same people for another 5 years - but in the NHS, people who speak out are ostracized

 

 

Whistleblowing

 

0:34:30

Eventually Steve lost all his work when he made a Protected Disclosure to the Quality Care Commission (QCC) about changing reports, bullying of staff - Steve had been hired to train nurses - he gave them an exam at the end because he knew they didn't know what they were training - suddenly they only wanted him to do the exam, not the training - Steve said these new graduates would fail his exam without training

0:35:30

There was an external review of Steve's complaints but he's never heard about it since - although they interviewed Steve, he's never seen the QCC report - he been blacklisted and that cost him some work - Steve had to reinvent his career - interestingly, other parts of the UK are inviting him to talk about this because they realize treating staff poorly is bad for patients and they can't recruit workers - Steve didn't want to be a whistleblower, he just wanted to do his job properly

0:37:00

The report was in 2014, but nothing has changed - Steve is involved with a group Whistleblowers UK - currently is a worker raises concerns about patient safety you'll probably lose your job - but the profile of whistleblowing has grown, and maybe at a tipping point - partially due to lack of staff and trouble recruiting

0:39:00

In part, due to Brexit, many foreign workers have gone back to their home country - reforms in 2012 was a disaster - Steve has looked at health care in other countries, and they have same problem

0:40:00

The problem recruiting is the culture of arrogance - Steve believes patients are their own best experts, and clinicians have got to change, there is no choice - must change some fundamental things - 'shared decision making' between clinician and patient is wrong, an arrogant way to look at it -

0:41:00

Clinicians provide information, patients make decisions - this change is happening fast and nurses and doctors are resisting - its a threat to their power - Steve doesn't want any power over people, because it works for everyone - if patients may make a bad decision and it won't reflect on the clinician

0:43:30

Heavy workload contributes to high rate of physician suicide - a high profile topic at the moment - some research has shown some physicians have committed suicide because of bullying - Steve does a lot of medical education now around patient safety and uses patients as co-instructors - his colleague Sam teaches with him on mental health

 

 

Labels can harm

 

0:45:00

Sam was and is a user of services, and Steve was his nurse - they teach the classes equally, they both get paid, there is tokenizing patients - Steve is developing that approach more and more - he often uses anonymized stories to tell about what helped

0:46:30

Patient safety in the UK is an industry, hierarchical - Steve will share stories with his audience in a helpful environment to talk about what would've been done differently - Steve also talks about errors his made - for example, he had a client who was labeled as 'aggressive' and Steve followed the care plan that said this person had borderline personality disorder and hinted strongly she was manipulative

0:48:00

Steve basically fobbed this person off, but came across her a few years later in a different environment with a longer assessment session - Steve realized that the care plan he'd been following, and notes about her, was wrong - Steve managed to get the notes changed, the care plan changed, a note from the psychiatrist and the diagnosis changed, and this person is now a psychologist

0:49:30

Steve has some problems with diagnostic labels - in mental health they can be really unhelpful - a 'working diagnosis' may be helpful if shared with the patient to work together - but that is often not done - and for doctors to get paid, they have to give a diagnosis, ticking a box

0:51:15

Labels come in fads - in early 2000s, it was borderline personality disorder - now its emotionally unstable personality disorder - Steve worked in a place where there were 2 psychiatrists, one often labeled a patient as borderline personality, and the other would label same patient as schizophrenic - the treatments are totally different, and they may not have either

0:52:30

Ticking the box contributes to clinician burnout - pressure to diagnose and create a care plan - Steve was not allowed to spend more time to really figure out what was going on, and that is destroying mental health services

0:54:00

Steve would like to do more medical education - he's involved with an organization called MedLearn with an approach to let patients be their best experts - he supports things that challenge the hierarchy in health care

0:56:30

It is still the norm not to pay patients for their contributions to research - and it is very patronizing

0:59:30

In the UK, patients often have 4 or 5 clinicians, who never communicate in any meaningful way

1:00:00

Steve thinks to change the medical culture, patients have to be brought in - there was a unit that was dysfunctional, lots going wrong - because it was specialist unit, there were patients on the board, and when they found out things were going on, then things changed - so patients on the board would help, and real patients - they don't necessarily have to have board experience, they can learn that - patients need to be in the hierarchy and involved with what's going on in a non peripheral way

 

 

Connect with Steve Turner

 

Twitter: @MedicineGovSte

 

Facebook: Steve Turner

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I am always looking for guests to share their medical error experiences so we help bring awareness and make patients safer.

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Scott Simpson: 

Counsellor + Patient Advocate + (former) Triathlete

I am a counsellor, patient advocate, and - before I became sick and disabled - a passionate triathlete. Work hard. Train hard. Rest hard.

I have been living with HIV since 1998. I was the first person living with HIV to compete at the triathlon world championships.

Thanks to research and access to medications, HIV is not a problem in my life.

I have been living with ME (myalgic encephalomyelitis) since 2012, and thanks in part to medical error, it is a big problem in my life.

Counseling / Research

I first became aware of the ubiquitousness of medical error during a decade of community based research working with the HIV Prevention Lab at Ryerson University, where I co-authored two research papers on a counseling intervention for people living with HIV, here and here. 

Patient participants would often report varying degrees of medical neglect, error and harms as part of their counseling sessions.

Patient Advocacy

I am co-founder of the ME patient advocacy non-profit Millions Missing Canada, and on the Executive Committee of the Interdisciplinary Canadian Collaborative Myalgic Encephalomyelitis Research Network.

I am also a patient advisor for Health Quality Ontario’s Patient and Family Advisory Council, and member of Patients for Patient Safety Canada.

Medical Error Interviews podcast and vidcast emerged to give voice to victims, witnesses and participants in this hidden epidemic so we can create change toward a safer health care system.

My golden retriever Gladys is a constant source of love and joy. I hope to be well enough again one day to race triathlons again. Or even shovel the snow off the sidewalk.