patient risk rather than share it.

Many speak of medicolegal risk,

can be more rational about risk

But blaming leads to greater risk

Dr Sue Ieraci Emergency physician in Sydney, NSW.

We commonly create‘ risk silos’, in which we construct walls around the risk we are prepared to carry.

Through referral, we pass the

but the chance of being sued by a patient or their family is— thankfully— low.

It is our colleagues’ finger-

than clinicians. If we clearly explain the relative risks of doing versus not doing, we can come up with a pragmatic

aversion, buck-passing and overregulation, which can harm patients more than protecting them.

Instead, let’ s all commit to culti-

risk on: GP to hospital; hospital

pointing that leads us to seek to

plan in which complications do not

vating intra-professional empathy,

Blaming other doctors when things go wrong blinds us to the lessons.

to GP; aged care to ambulance; ambulance to police service; ambulance and police to ED; ED to inpatient units.

protect ourselves from risk— often( ironically) at an increased risk to our patients.

Patients and their families

come as a surprise. Adverse events are not 100 % preventable, and we are all subject to imperfection.

trust that virtually no healthcare worker intends to do harm and we may all be less perfect than we like to think.

We are encouraged

to develop empathy for our

patients, but why can’ t we be

empathetic towards each other?

Why, even with hindsight,

do we often tend to assume we

would have done better when

something goes wrong?

I thought about this again

when we heard of the guilty verdict

handed down on the police

officer who had used his taser

on a 95-year-old woman with

dementia in an aged care facility.

He had been called in because

the frail, 47kg Clare Nowland was

brandishing a steak knife.

When she refused to put the

knife down, police officer Kristian

White had said“ bugger it”

and tasered her, causing her to

fall with fatal results.

While it is tempting to see only

the error in the terminal event, it

is much more rational to see it as

the end of a long sequence, which

may have started weeks earlier.

I can’ t defend White’ s behaviour

or his non-custodial sentence

for manslaughter, which

the prosecution is appealing as

too lenient.

My concern is that, by focusing

only on one person’ s conduct

and making assumptions about

what we would have done, we

miss an opportunity to prevent

similar incidents in the future.

First, we do not know

whether this woman had a history

of aggressive behaviour.

Was she on too many anticholinergics

? Did she have early sepsis

? Did she have untreated pain?

Was medication offered and

refused? Could this event have

been foreseen by the caring and

treating team?

Were enough staff present to

manage the situation overnight?

Did they know this woman?

Was it the facility’ s policy to

call the police?

Were there enough experienced

police on duty overnight?

It is easy to be critical after

the event. Why couldn’ t the onsite

staff manage? Why couldn’ t

the ambulance officers manage?

Why didn’ t the police officer have

more patience or more wisdom?

During my career, I have seen

the tendency for intra-professional

criticism and blame escalate

alarmingly.

We have become risk averse

and seek to isolate ourselves from