Introduction

The cover-up culture is currently rife. Stories of institutions covering up abuse, are hitting the headlines at a pace. As I watch stories like The Vagina Mesh scandal, The Lucy Letby case and The Post Office scandal come to light, I can relate. My story, whilst not yet exposed, is a cover-up. There have been many incidents, where clinicians have not been honest about clinical findings, and have covered up evidence. Institutions now cover-up for one another by default.

Aside from the burning pain of injustice, it is heartrending feeling silenced by an inhumane system, that protects its own. My intelligence has been insulted, so it is vital to me, that the clinicians who have been involved, know that I have clocked every occasion, when a clinical finding has been covered up, medical records have been amended, and the truth has been hidden.

I am writing about this sensitive subject, because I want to see change. One woman’s story is potentially every woman’s story, and I do not want to see another person go through what I have. I want to see more transparency with clinicians, and more accountability for how doctors behave. Personally, I am living with a level of fury and despair, that I cannot carry alone anymore. I have to speak. Everything that I chronicle in this post is true and accurate. If there are consequences for me speaking out about this, I will happily accept them. I will not remain silent about clinicians who are neglecting their duty of care, and in some cases, breaking the law. A story like mine has the potential to inform change, and it is vital that voices like mine are heard.

There is a culture of cover-up in the NHS. There is no point pretending that everybody is nice and does the right thing.

Rob Behrens, Health Ombudsman

Incident 1

A private rheumatologist referred me to an Oral Maxillofacial surgeon, re the pain in my left parotid gland. I saw this surgeon at a Salivary Gland department, at a London NHS Hospital in February, 2016. The first sialo gram that he did showed obstruction in my parotid gland, which he washed away. When the surgeon wrote back to the referring rheumatologist, he did not mention in his clinic letter, that they had found obstruction in my gland.

The rheumatologist referred me back to the surgeon in June, 2016. A different consultant did an ultrasound, which showed a thickening of saliva, known as ‘mucous plugging.’ The consultant referred me for a Sialendoscopy. In December, 2016, I saw a registrar at the unit, who did the sialendoscopy. When she entered the endoscope into my papilla, we both saw on the screen, at the top of my parotid duct, big clumps of what looked like white clouds. ‘It’s bad in there,’ she said. ‘I am going to refer you for wash-outs, every 6 weeks.’ She handed me a green form, which I gave to the receptionist as I left the building.

A Dental Radiologist

I received an appointment to see the Head of Dental Radiology one month later. She works closely with the surgeon, who initially referred me to the unit. His initial referral letter had said; Please do these investigations, to prove that there is nothing wrong. This dental radiologist did a second sialendoscopy, which was incredibly healing. On leaving the procedure room, I asked her when I would hear from the consultant. ‘I haven’t written my report yet,’ she said.

In February, 2017, I saw the female consultant. ‘I’m discharging you,’ she said. ‘Everything is normal.’

‘That doesn’t make sense,’ I replied. ‘The registrar referred me for ongoing wash outs only 6 weeks ago?’

‘The dental radiologist has said that everything is normal.’

She appeared. There was a kafuffle between us. ‘Everything is fine,’ the dental radiologist said.

‘How can so much of changed, from when I saw the registrar 6 weeks ago?’

‘Maybe that was a mistake,’ she replied.

They discharged me. Case closed. I wrote to the NHS Trust and complained that the salivary gland unit had prematurely discharged me, only 6 weeks after the registrar had assessed me as needing regular wash outs of my gland. They sent me an appointment to return to see the lead dental radiologist.

Trip!

When I returned to see the Dental Radiologist at the salivary gland unit, she tripped. There were four registrars in the room, who were preparing for the procedure, while the dental radiologist was doing an ultrasound of my parotid gland.

‘You haven’t frozen the image!’ One of the registrars whispered, pointing to the screen.

‘Oh yes, silly me,’ the dental radiologist replied, and clicked on the mouse.

I jumped out of the chair. ‘Have you not been freezing my ultrasound images?’ I asked. The registrars looked down. ‘I can’t go through with this,’ I said. ‘You are not an honest clinician.’

‘But we need to do this procedure, Felicia. Your gland is not working as it should.’ That’s where she tripped.

 ‘You’ve just admitted that my gland is not working! I was discharged from here six weeks ago, because you told the consultant that “everything was normal.” You are not being honest about these findings,’ I said.

‘She’s just having a wobble,’ the dental radiologist said to the registrars.

‘No, this isn’t a wobble,’ I replied. ‘I cannot trust you.’ I walked out.

The dental radiologist had not told the truth. This was proven in the histology report from my superficial parotidectomy 1-yr later, which showed dense secretions in the ducts and numerous calcifications. Each time I see a new clinician, they phone the dental radiologist for her opinion. She tells them that everything was normal. They believe her, and the fib is perpetuated.

I see evidence where patients have been lied to, and there are a whole series of incidents where people do not know what went on and hospitals are reluctant to disclose this. You can call it whatever you like but it is a cover-up.

Rob Behrens, Health Ombudsman

Incident 2

In May, 2019, I saw a Head and Neck surgeon at another NHS Trust in London. He is a close colleague of the surgeon mentioned above. In; On Medical Gaslighting #1, I explain that it looks possible, that this NHS Trust have deleted some images from an MRI Neck scan. After 4 scans, I saw on the surgeon’s screen, a radiology image with white blobs on the left side of my face. I asked him if they were calcifications. He said ‘no,’ and turned his computer off. I asked to see the image again, but he refused.

I requested the radiology images from the NHS Trust. When I received the disk, there was a missing file icon next to the MRI Neck Scan. When I clicked on that scan, a sign appeared which said; error decoding images. I queried this with the NHS Trust, and they told me that they had merged those images with another scan. That may be true, but I cannot find the images on the disk that I have, that I saw on the surgeon’s screen in 2019. I think that it is possible, that a series of images may have been deleted, as part of this cover-up.

Incident 3

I have a query re the transparency of the radiologist, who reported on my CT Neck radiology images in July, 2020 at an NHS trust in Scotland. He reported everything as ‘normal,’ but there is a stark asymmetry between the two sides of my face, that still needs explaining.

In; On Mental Health Discrimination #1, I chronicle how a Head and Neck surgeon wrote a discriminatory comment about me on the scan request form, which he sent to this radiologist. I believe that the surgeon’s comment may have caused this radiologist to not report truthfully about these radiology images.

Incident 4

I saw an ENT consultant at an NHS Trust in England in July, 2022. He ordered an MRI Neck scan, which showed abnormality in my left buccal fat pad.

I saw an Oral Maxillofacial surgeon, who had the radiology report, which confirmed the abnormality, in front of him. During a horrendous consultation, the surgeon proceeded to change my radiology images on his screen, saying that the images are ‘squint’ and ‘off axis.’ I showed him CT radiology images that I had on my I-pad, and he told me that the quality of my I-pad was s**t. The surgeon gave me no explanation about my abnormal MRI scan. He took no action.

Incident 5

At this time; July, 2022, I logged into my TPP System One account and saw that my GP had written in my medical records; Scan abnormal. To be expected. No further action. This was shocking. Whilst I have sympathy for how consultants have ghosted my GP’s, a GP still has the power to ask questions and advocate for the patient. This GP has done neither. They have pulled down the shutters, and colluded with the cover-up.

A serious incident occurred with my GP re this comment. On 8^th December, 2023, I attended an appointment with the Mental Health Team to request medication to aid my sleep. I told a clinician from the team that I had seen my GP’s comment on my medical records. When I got home from the appointment, I logged into my TPP System One account, but my username and password, that I had used for 2 years, did not work. I tried it many times, but I was locked out.

On 12^th December, I phoned the GP practice. I told them that they had blocked me from entering my account. They provided me with a new username and password. To my horror, when I entered my online account, I saw that between 8-12^th December, 2023, my GP had amended that comment. They had added to the entry; Review not applicable. 

Good Medical Practice

Good Medical Practice states that a doctor ‘must’ make sure that formal records of your work, (including patients records) are clear, accurate, contemporaneous and legible.’ (69) [1]The footnotes explain that contemporaneous means making records at the same time as the event you are recording, or as soon as possible after. ‘You must,’ is used for a legal or ethical duty you are expected to meet.’ [2]My GP making an amendment to my record, 17 months after the event, is not contemporaneous. The GP has not adhered to their legal duty.

Amending Records

The Medical and Dental Defence Union (MDDUS) state that late additions to notes ‘should be added, with a clear note alongside explaining when the note was made, and the reason for the delay.’ MDDUS states that ‘clinicians must have a legitimate reason to alter a patient’s record. Any changes must be clearly marked, showing the name of the person making the change and the date the change was made.’[3]

When making changes to electronic records, the principle of transparency is paramount. Any alterations found to have been made without an accompanying explanatory note, such as the insertion of new notes, will be viewed seriously by the regulators and could lead to accusations of dishonesty.

Medical Dental Defence Union, Scotland

I felt threatened by this incident, particularly by how quickly the Mental Health team blew the whistle to the GP. The GP has not added any explanatory note, explaining why this amendment was made, when, or by whom, anywhere on my records. The black line in the image above is the doctors name being marked out. I can see no ‘legal basis,’ or ‘justifiable cause’ for the GP to have made this amendment, 17 months after the event, apart from the GP practice covering their backs. This incident was particularly concerning, in light of the fact that there was a serious incident at my GP Practice, which hit the headlines, only four months before they amended my records.

Never alter patient records without a legal basis or other justifiable cause.

Medical Dental Defence Union, Scotland

It’s Endemic

This cover-up is bigger than the individual clinicians involved. It is now endemic, which is why I have 1) stopped going to consultations, and 2) not moved to my eighth GP Practice. It keeps happening, and it won’t change until there is a paradigm shift. Clinicians keep up the falsehood, because if one of them was to admit there is actually a clinical problem, the House of Cards would fall.

Reflection

It is menacing how complacent these institutions are with behaving in this dishonest way. There’s a safety in numbers psychology; clinicians cover-up, which gives colleagues the license to do the same. My GP clearly thinks nothing of amending my records. What is so sinister, is that when I turned to the Mental Health Team for support, they told me to ‘reframe’ the situation, that ‘I don’t like what I hear.’ To put the responsibility of 11-years of systemic duplicity onto me, when one of their clinician’s has recently been complicit in the cover-up, is scandalous.

Every time an NHS scandal hits the front pages, leaders promise never again. But the NHS seems unable to learn from its mistakes and we see the same repeated failings time and time again. Health Ombudsman

Rob Behrens

Rob Behrens, the Health Ombudsman published a report into the cover-up culture in June 2023. He points to “the gaping hole” between policies aimed at improving patient safety and real-life experience on the ground, with hospitals “routinely” failing to accept their errors. His office highlighted continued failures to accept mistakes. He states the main causes of harm are; failure of staff to make the right diagnosis, delays in giving treatment, and a failure to listen to patients. Further harm is caused to patients when NHS trusts carry out poor quality investigations, fail to learn, and offer inadequate apologies.’[4]

Philip Schofield Scandal

I want to draw on the candid interview that Phillip Schofield gave to the BBC in June, 2023, after it emerged that he had been having an affair with a younger runner at This Morning. Amol Rajan asked Phillip ‘Why now? Why has this all come out now? What was the catalyst? Phillip answered; ‘The lie just got too big. It started as denial. It turned into a lie. The lie grew legs, and then it just got way too big.’

My medical story started with denial. The dental radiologist then didn’t tell the truth. Other clinicians believed her and felt that they had to be loyal to the deceit. The lie built and has grown legs. Now it is so big, that clinicians are backtracking on clinical findings and amending records. Gaslighting has become the dominant tactic to keep me silenced, which has become too threatening. That is why I have walked away.

Conclusion

These incidents have traumatised me, particularly the recent incident with my GP, locking me out of my account and amending my records, without being transparent about why. I have not slept properly since and my mood has become dangerously low. This has to stop. I need to know the truth; what is causing my facial pain, and what can be done about it. These medical professionals need to start being honest. It is not serving them to be getting away with deviating from GMC guidance like this. This is a cover-up. It is time for some long-awaited truth, accountability and liberation for everyone involved.

Cover-ups of mistakes must be challenged and accountability has to be at all levels. We need to see significant improvements in culture and leadership.

Rob Behrens, Health Ombudsman

Foot Notes

[1] The General Medical Council; Recording Your Work Clearly and Accurately; Good Medical Practice. Published August, 2023.

[2] The General Medical Council; Good Medical Practice. Published August, 2023.

[3] Altering clinical Records-Do’s and don’ts; MDDUS, mddus.com

[4] Kirby J; Ombudsman Finds ‘Culture of Cover-Ups’ in NHS When Patients Are Harmed, The Independent, June, 2023.

Recommended Articles

https://www.ombudsman.org.uk/news-and-blog/news/nhs-must-make-patient-safety-more-just-promise

Photo Credits; Tina Miroshnichenko, Daniel Frank, Markus Winkler and Andrea Piacquadio on Pexels. Ocean Bigshott, Daniel Monteiro, Mark Stuckey, Priscilla Du Preez, Jacki Drexler, and Sigmund on Unsplash.