Power without responsibility

It's a deadly combination, power without responsibility, as we've seen with MPs' expenses if people are allowed to do what they want with little fear for the consequences then they will behave quite appallingly and unethically. One of the best ways of ensuring high standards in any system is to ensure that those people who are making important decisions are made accountable for them, after all if something goes wrong and no one is at all accountable, then the same errors will continue to made time and time again. What relevance has this for the NHS, quite a lot I would argue.

I had the misfortune of encountering a rather arrogant and obnoxious radiographer the other day. Radiographers are the technicians who take XRAYs, CT scans et cetera. I have to say that most of the standard radiographers I come into contact with are very pleasant people. The problem is that as with all things in the NHS, radiology has started to be dumbed down, some radiographers have now been empowered to actually report XRAYs as 'reporting radiographers'.

Don't get me wrong, radiographers see a hell of a lot of XRAYs and are very good at spotting fractures, better than a lot of doctors in fact. Unfortunately they are not medically trained, they are not radiologists, meaning that they do not have the broad base of knowledge and training that enables them to think outside the box and think of rare pathologies. For this reason 'reporting radiographers' are only allowed to report a very small percentage of the XRAYs that are done. There is still a problem as what happens when a 'reporting radiographer' misses that rare abnormality that a radiologist would most likely have picked up, I get the distinct feeling that they would not be held to account as a radiologist would be.

Radiologists are notoriously cautious because they know how tricky interpreting XRAYs and other tests is, most of the time one can see the obvious answer straight away, however if one just jumps straight in without thinking one would never diagnose the subtle, rare and potentially career-ending-if-missed pathologies. Radiology is like a minefield littered with the occassional career ending mine, most of the time one will be OK skipping through nonchalantly, however if one skips for long enough one is sure to get blown to smithereens.

I have digressed. The point I was trying to make was that the rather obnoxious 'reporting radiologist' was so overly confident because they lacked the knowledge and insight to be aware of their own limitations, they were skipping through the minefield assuming that their luck would hold. The particular one I met chose to take a quick glance at the XRAY, then claim that it was completely normal and should never have been done. I kept quiet and didn't mention that a rather esteemed Consultant surgeon had a very good clinical grounds for performing the XRAY. This is power without responsibility in the NHS, it generates this rank arrogance in the ignorant, it creates a potentially lethal over confidence in those who do not have enough knowledge to realise their own limitations. I could move onto the tale of the osteopath who reports XRAYs and misses bone tumours the size of footballs, but I would want to get sued for insulting a quack would I?