When future historians – or historian-robots – look back at us, what will they determine the last good day to have been a doctor? Post-pandemic, when the wheels finally came off and medical professionals had to strike to call attention to their etiolated pay, chronic underfunding and the NHS’s impending doom? Pre-pandemic? Pre-Thatcher? Or before more ineffable notions crept in, such as the growing distrust of experts, patient entitlement, or the rise of ambulance-chasing lawyers encouraging even the most mildly and unavoidably inconvenienced to sue?
We are a long way from the well-ordered worlds of Dr Welby or Kildare now. Dr Finlay’s casebook would be a groaning, overstuffed thing filled with intractable problems. Even ER, with its gunshot-riddled beds and patients dying from lack of insurance, is starting to look like the representation of a golden age.
Malpractice plunges us into the unforgiving world that today’s doctors work in. Intricately plotted and beautifully, leanly written by Grace Ofori-Attah, who spent 10 years as a doctor in the NHS, it stars Niamh Algar as Dr Lucinda Edwards – whose only averagely stressful life and career are derailed when an overdose victim dies in her care. The father of the dead girl, Edith, contends that it is the result of negligence. From there, Ofori-Attah explores the black, white and grey areas in medical practice as the investigation into Edwards’ actions and decisions that night digs deeper into her background, and its discoveries prompt her to start some clandestine inquiries of her own.
At first, Edwards’ situation looks like the result of an unlucky but far from incredible confluence of circumstances. A busy shift, an absent consultant, an inexperienced colleague are all working against her even before the patient arrives. They are just beginning to stabilise Edith when a man waving a gun arrives in reception demanding attention for his badly injured child. Edwards leaves Edith in order to deal with the emergency and deems that, as there are no beds left and Edith is the least critically ill, she should be moved out of A&E under the care of inexperienced Ramia. Before they leave, however, we see Edwards change Edith’s notes to read “deliberate” rather than “accidental overdose”. We also see her give clear instructions to Ramia regarding Edith’s treatment but, with the pressing need to get back to her bullet-ridden emergency, not write them down nor fully check she has understood. Ramia does not deliver the intended treatment. Edwards saves the injured child’s life, but Edith dies.
So – who or what is to blame? The consultant who left his shift early to pick up his child? An overstretched system that doesn’t allow enough beds or time to absorb extreme emergencies? The shooting? Edwards’ failure to write things down in accordance with protocol? Ramia for not listening – or being clear that she didn’t understand? All of the above? None? Does it matter that the consultant would be less automatically covered-for after leaving early to get his son if he were a woman? Or that the learning curve of baby doctors (“See one, do one, teach one” is the famous mantra, as Edwards reminds her proteges early on here) is so steep it is impossible for them not to tumble off it at some point?
What are we to make of the fact that Ramia attenuates her account of the instruction-giving when the investigation begins? Or that Edwards physically pushes Ramia out of her way in fury and frustration as she abandons futile CPR, walks away from Edith’s body, and calls her stupid? How should we respond to the alteration to the notes? Or the pills Edwards has hidden under her mattress at home?
Later in the series the focus broadens and the plot thickens (and periodically becomes unbearably tense) to make it more of a thriller, but it doesn’t lose touch with the central theme. The first episode tracks the subtle shifts in power relations among those being investigated and examines people’s willingness to compromise, as well as the different kinds of cowardice that come to the surface under stress. It looks at what difference love, attraction, friendship, private experience, unprocessed grief and guilt can make to the interpretation of events. As the five-part series goes on, the action ramps up, with several twists and turns to the plot that invoke the effects of Covid, of maternity leave and returning to work, medical corruption and bureaucratic inefficiencies that – with the caveat that I haven’t yet seen the last couple of instalments – don’t take us off into the land of deep implausibility.
Ultimately, the drama poses the question of how much reality, in the form of human fallibility, we can bear when it comes to doctors, healthcare and the NHS. Should we, can we, possibly learn to tolerate a certain number of mistakes in a system run for and by ordinary people, albeit sometimes with extraordinary lifesaving skills? Will we always be collectively too immature to contemplate such a thing – or is this not an appropriate goal to have? As viewers, we are made to wonder: what is best practice for us all?
• Malpractice aired on ITV and is available on ITVX
