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NEWS: Katherine Burke Professor Sir George Alberti BMJ 2004; 328: 127-c [Full text]

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Enforcing improvements in the standards of emergency care.

Richard G Fiddian-Green   (25 January 2004)

Enforcing improvements in the standards of emergency care. 25 January 2004
Richard G Fiddian-Green, None None Send response to journal: Re: Enforcing improvements in the standards of emergency care.	Professor Sir George Alberti has observed that the government and the profession are seeking ways to ensure continuing competence because of the almost daily accounts in the media of doctors, some of them physicians, who have failed to achieve appropriate standards (1). The Shipman "murders" is a notable example. He further observed that the Royal College of Physicians "recognises the resource consequences of the several elements of clinical governance, and it regularly points this out to the government". He added that, "if the public truly wants assurance of continuing high standards of medical care it must pay for it". Now that Professor Sir George is working for the government as national clinical director for emergency access could he comment on the means the government has been using to improve the standards of care. More specifically does he have any knowledge of covert actions having being taken to make scapegoats out of doctors, whose practices might have been considered unacceptable and/or politically incorrect? If parties in the government have ben doing thise I would have edexpect them to conform with the "law of rationality" in having credible reasons for fatalities or complications to conceal the covert sabbotage. In Shipman's case for exampple that might conceivably have been his history of drug abuse, and/or knowing that the doses of narcotic he was accustomed to administering were usually too large and/or considering the indications for some of his administrations having had no credible evidence-base. Christiaan Barnard claimed that Princess Diana's death was avoidable, the implication being that she could have received better emergency care. That is certainly true for exsanguinating haemorrhage from penetrating wounds inflicted in war and civilian combat zones, blunt trauma, and ruptured aneurysms. Outcome is invariably fatal in the former and in the case of ruptured aneuryms has not improved apprecaibly in decades. Some would argue that there have been improvements in the latter cases. If so they have been marginal and not of the order needed and judging from animal studies t have been realistically possible for decades. Sir William Osler once said that if one's management was being effective one should continue with it but if it was not then to try something differently. Trying something different is long overdue in these cases. It is not clear to me if and just how Professor Sir George Alberti intends to address these important issues in a timely and effective manner. If Princess Diana's crash was the product of covert sabotage as some have suggested I would expect it to have conformed with "the law of rationality". By all reports the driver had been drinking and was to blame. The real question is whether he gave the appearances of drinking anticipating some form of covert action but not knowing the form it might take. Knowing the blood levels of alcohol is, therefore, of paramount importance in re-evaluating this case. It is difficult for me to believe that a driver given responsibility for driving Princess Diana would ever have risked having a drink whilst on duty especially if he had witnesses. One might even argue that Princess Diana had even provoked a attempt against her life or that someone had used hr as a decoy to find and convict those responsible. That Shipman was unable to understand why the concentrations of drug in the blood of his deceased patients had been so high should be reviewed in terms of the possiblity someone had made him a scapegoat as a warning to others who chose not to conform with politically correct thinking. I only hope that if so the intention was not to draw attention to the deficiencies in the standard of care for these problems in France. 1. Andrew Whitehouse, K G M M Alberti, and John R Bennett Proposed appraisal system and political correctness BMJ, Jul 1999; 319: 53. Competing interests: None declared