Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Re: Culture of ignorance and arrogance.
- Richard G Fiddian-Green (14 June 2009)
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How safe is the patient without the hospital?
- Stephen J Main (28 June 2009)
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Sitting leaders ask you to stand up for safety
- Peter T Wilmshurst (29 June 2009)
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Richard G Fiddian-Green, FRCs, FACS None
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Dr James Bagian, doctor and former astronaut, says medicine has a "cottage industry mentality employing vituosos who collaborate badly..In medicine there is little understanding of such systems, no training in them, and a culture of ignorance and arrogance. Other industries are culturally different". Coming from a VA doctor that is the pot calling the kettle black for, despite Khuri's evidence to support the claim that surgical care in the VA hospitals is no worse than that in the private sector, the median standard of care in the VA and the cohort of private hositals chosen is lousy and would seem to remain lousy years after the VA implemented their improvement program. Kevin Cleary puts his finger on a major problem in the NHS, poor handover between shifts. It is also a problem in the VA and indeed in all of US medicine. Dr Bagian offers a solution to that. One cannot,however, transfer responsibility in surgery without compromising care. It never works. It is a fact of life that surgeons take better care of their own patients than others'. They always will, its a question of ownership and responsibility for one's own actions. One knows what one did and what might have gone wrong and is usually in a better position to manage the problem than anyone else. Yet the EU theatens to impose a 48H working week and make handovers compulsory even in surgery. What a disaster (1). I get the feeling that some of those in authority in the VA have decided that they know how to do it better, even if it takes them 10 years to implement their changes. It might work for medicine but it will not work for surgery. Having said that major changes in management are in order, as I have argued in previous electronic communications. I made my case to the VA and the Uniformed Services University of the Health Sciences In Washington shortly after the end of the Gulf War. That's almost 20 years ago. I would not bet on Dr Bagian's check list being implemented in 10 years. 1. John House. Calling time on doctors' working hours. The Lancet, Volume 373, Issue 9680, Pages 2011 - 2012, 13 June 2009 Competing interests: None declared |
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Stephen J Main, Medical officer (GP) Hokianga Health Rawene Hospital, Hokianga, private bag Kaikohe 0440 New Zealand
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Quoting from this article : "Health care is a dangerous business. One in 300 patients admitted to hospital will die as a result of medical error." While not intending in the least to deny the need to improve safety in medicine the following question must be asked: How many of those 300 people would have died had they not been able to be admitted to hospital for treatment? And again: "Would anybody ever get on a commercial airline flight if told before boarding that the chances of dying were 1 in 300?" In general, people are not admitted to hospital for the same reasons they get on a plane. However, if I were told I had a 1 in 300 chance of dying if I got on the lane but a 1 in 30 chance of dying if I didn't, I could well feel that getting on this rickety plane was still a good option. I was not present at this conference and maybe the appropriate figures I ask for had been researched and presented. They are pivotal to the whole issue of safety that this article addresses. If you do not know the natural history of a given medical situation ten you cannot comment usefully on whether your treatment is doing harm or good. It is vital to minimise errors and consequent harms, but they are unlikely ever to be reduced to zero and before we indulge in more self- flagellation we need to see the current level of error against the perspective of what would happen if no intervention were made at all. Competing interests: I am a member of this beleagured profession and like most I try not to make mistakes but fear that I sometimes do |
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Peter T Wilmshurst, Consultant Cardiologist Royal Shrewsbury Hospital, SY3 8XQ
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A reduction in medical error is something that doctors should desire.[1] But combating medical errors by enhanced reporting in a culture where doctors conceal errors and misconduct presents difficulties. If junior doctors follow the recommendation of medical leaders and stand up for the safety of patients will they receive support from those leaders? In the same issue of the BMJ we read “Staff concerns about safety at Mid Staffordshire trust were lost in a black hole”.[2] The evidence suggests that those whistleblowers who report concerns are treated no better in the NHS now than at the time of the scandal at Bristol Royal Infirmary.[3] It is our medical leaders who are responsibility for the culture of silence. To become a medical leader one needs to compromise principles for expediency to meet the demands of those politicians (within an organisation or government) with the power to advance or destroy a career. Medical leaders lack moral authority because few of them have taken the risk of speaking out on their way to the top. They are too often complicit in concealment of problems in order to protect their organisations or political masters.[4] For 25 years I have had dealings with doctors who have blown the whistle. Many left medicine because the response of senior management to a whistleblower was to attack and discredit the messenger. In one case a health authority spent over £2million, which could have been used for patient care, in legal costs in years of groundless court actions against a whistleblower. Dr Fiona Godlee spoke at the conference and represented the BMJ. The BMJ has removed from its website articles that have appeared in the paper journal purely to avoid the risk of the journal being sued for libel. The articles have not been retracted because there are no grounds for retraction of truthful reports. Does the BMJ want junior doctors to take the risk of losing their careers by speaking out, when the journal is afraid of the financial cost of speaking? Sir Liam Donaldson also spoke at the conference. I have had correspondence and meetings with the Chief Medical Officer to discuss misconduct by doctors, but I am left with the opinion that the CMO is unwilling or unable to act when the allegations involve senior medical leaders. Yet Sir Liam wants junior doctors to be brave enough to speak about problems. I was not present at the conference reported in the BMJ but I am concerned that motivational speeches that junior doctors receive from medical leaders are the types of pep talks soldiers received from generals before the troops went over the top at the Somme and the leaders went back to their chateau for lunch. It is time for our medical leaders to lead from the front and share the risks. 1. Hawkes N. Standing up for safety. BMJ 2009;338:1416-7. 2. O’Dowd A. Staff concerns about safety at Mid Staffodshire trust were “lost in a black hole”. BMJ 2009;338:1408-9. 3. Gooderham P. Changing the face of whistleblowing. BMJ 2009;338:1341-2. 4. Wilmshurst P. Dishonesty in medical research. Medico-Legal Journal 2007;75:3-12. Competing interests: None declared |
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