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• Response to Charles Essex
  Harvey Marcovitch
  Published on: 9 January 2022
• More is not necessarily better
  Charles Essex
  Published on: 9 January 2022

• Published on: 9 January 2022

  Response to Charles Essex

  • Harvey Marcovitch, syndication editor

  When the paper was first submitted it did not identify the patient's name or address nor where she was treated. Unfortunately I did not think to seek information on the treating team from the subscriber to ADC who submitted it on the family's behalf. I have checked the audit trail and remain uncertain as to how the acknowledgement found its way in - but I take full responsibility and apologise to anyone who feels bruised...

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  When the paper was first submitted it did not identify the patient's name or address nor where she was treated. Unfortunately I did not think to seek information on the treating team from the subscriber to ADC who submitted it on the family's behalf. I have checked the audit trail and remain uncertain as to how the acknowledgement found its way in - but I take full responsibility and apologise to anyone who feels bruised by the publication. I had assumed that our informed readership would realise there can be a world of difference between a family's perception and the clinical facts. But I still think perceptions can be important learning points. Overall, I plead incompetence rather than disingenuousness.

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  Conflict of Interest:
  None declared.

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• Published on: 9 January 2022

  More is not necessarily better

  • Charles Essex, Consultant Neurodevelopmental Paediatrician

  Dear Editor,

  Frances’s story raises several points. Firstly, I am sure I am not alone among readers in having every sympathy with Frances's mother and grandmother. I find it is a Canute-like task trying to stem the flood of expectation among professionals and parents that “more must be better”. There is an erroneous belief that more investigations, more professionals involved, more interventions, more physiotherap...

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  Dear Editor,

  Frances’s story raises several points. Firstly, I am sure I am not alone among readers in having every sympathy with Frances's mother and grandmother. I find it is a Canute-like task trying to stem the flood of expectation among professionals and parents that “more must be better”. There is an erroneous belief that more investigations, more professionals involved, more interventions, more physiotherapy or speech therapy or occupational therapy, etc., must be a good thing.

  Many in the caring professions believe they are acting in a caring way by advocating more interventions and making referrals to all and sundry. But just because the services or technology are there, we do not have to use them. As paediatricians we must take the lead and when appropriate say, “Stop”. We need to have the courage to say, for example, “Treat the child and not the growth chart” and mean it.

  Secondly, the arousal gap means that every phrase, silence and gesture is given a meaning by the patient or family far beyond its intention.[1] The fact that the family is aggrieved does not mean that there has been poor communication, that anyone is at fault, and that the fault automatically lies with the doctors. Families and doctors are both in a difficult position. Doctors have to give unpleasant, distressing, complicated information about issues which are not clear cut to families at times of great stress, anxiety, unhappiness and fear. There might also be guilt and anger. What we should remark on is not when this process goes badly but how often it goes well.

  Thirdly, Harvey Markovitch is being disingenuous when he says, “We were not in a position to ask the doctors whether their perception of the situation was different”. With the parents’ permission he could have had a parallel article with the doctors’ version of events. Anonymous articles are potentially a libeller’s charter. The “acknowledgement” at the end of the article to staff in the Dartford area will inevitably suggest – rightly or wrongly – to readers that the incident took place around that area. This may cause immense distress to the doctors concerned who may recognise themselves and possibly be recognised by colleagues [R Taylor, personal communication]. They will rightly in my opinion feel aggrieved that they have not been invited to or are unable to respond.

  References

  1. Metcalfe D. Doctors and patients should be fellow travellers. BMJ 1998; 316: 1892-3.

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  Conflict of Interest:
  None declared.

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