Quality in Primary Care Open Access

I doubt that any doctor can deny having wished, perhaps with a degree of nostalgia, for a return to the days when their qualifications, position and experience conferred upon them automatic respect and trust. This may still have been the case were it not for the many scandals that have rocked the profession and healthcare institutions over recent years. Nostalgia, however, is all well and good, but it should now be hoped that some significant good could emerge from the funeral pyre of blind trust.

As a result of such scandals, much has been written on the subject and this book, clearly and logically written, contributes a great deal to the debate. From the eloquent and thought-provoking foreword by Rabbi Julia Neuberger and excerpts from the Bishop of Liverpool’s address following the Royal Liverpool Children’s Inquiry, the authors guide us succinctly through a range of concepts, perspectives and responses. A potentially ‘dry’ subject is animated and its relevance to every working doctor is illustrated well.

The perspective of the patient (‘non-trust’ rather than ‘distrust’) is examined and its changing nature explored along with the emerging culture of suspicion. The most prominent scandals of recent years, those of Shipman, Bristol and Alder Hey, are revisited and an attempt to make some sense of the process and shortcomings is made, as well as an analysis of how ‘the system’ has responded.

The revisiting of crimes past and overview of responses provides a good basis for the second part of the book, which teases out the complex nature of how trust in medicine has its origins in all corners of society from literature to media, from universities to hospitals and from the practice of using error to review, learn and revise. The importance of the doctor–patient relationship, of atmosphere and environment and of management systems is discussed and, I feel, considers all the relevant information.

The authors, however, do not leave the reader without hope, as the final section of the book looks forward and, in a gentleway, provokes the reader to do so too. The fact that there can be no return to the days of ‘blind trust’ is both acknowledged and welcomed and we are encouraged to embrace healthcare as a ‘service, not a product’. Our trustworthiness needs to be demonstrated in order to earn trust, they write, and this proposal is thoroughly described.

For any health professional affected or concerned by the events of recent years I would commend this book for its comprehensive and stimulating review of the basis of our relationship with our patients. To use the authors’ words, ‘ . . . the rebuilding of trust should be an urgent and serious endeavour for all’.

Specialist Registrar in Palliative Medicine

Leeds Teaching Hospitals NHS Trust