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Education And Debate

Five times: coincidence or something more serious?What should a junior doctor have done?You cannot expect people to be heroesPut out the fire or risk an infernoPresent system of whistleblowing is unsatisfactory

BMJ 1998; 316 doi: (Published 06 June 1998) Cite this as: BMJ 1998;316:1736

Five times: coincidence or something more serious?

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The anonymous article below was sent to us by a doctor outlining the concerns he had about the competence of a surgeon he once worked with when he was a junior doctor. We asked four other doctors what the junior should have done, what they would have done had they been approached by the junior, and what the implications are for the regulation of medicine.

Perioperative mortality (death within 28 days of an operation) has became a key surgical phrase in the past decade, particularly after the publication of the first report of the confidential inquiry into perioperative deaths. This document detailed a variety of surgical and anaesthetic disasters, and, although it pointed out that many perioperative deaths were and remain unavoidable, there were contributory factors such as inadequate hospital facilities, poor supervision of junior doctors, and inappropriate surgery in severely ill patients.

This and subsequent reports, together with regular intradepartmental and interdepartmental audits, have raised the awareness of perioperative mortality. All operative deaths should now be discussed to discover if care could have been improved or death avoided. I have been fortunate to be a surgical trainee in these more enlightened times. Usually, the audits I have attended have had an average of one death every six months from routine general surgery lists (somewhat more from emergency surgery), and even fewer during my five years in specialist training. With one exception: during a six month period on one firm, five patients on routine lists died from a variety of reasons. All of these patients were led to believe that their conditions would be substantially improved if not cured by the surgery, and yet within a matter of days they were dead. I felt at the time that certain questions were overlooked, if not ignored. My polite …

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