Wednesday, February 28, 2007

Hospitals Behaving Badly

Why is it that I only seem to see bad news? Is it, as Barbados Butterfly points out, that feel-good, all-goes-well news is not interesting?

Well, a little while ago this piece of masterful journalism was brought to my attention concerning an NHS trust in the UK being fined for inadequately supervising its Senior House Officers. The Australian link lies in that one of the SHOs was employed in Perth prior to departing for the UK. No doubt Dr Crippen will be familiar with it.

Hospital faces up to patient death - BBC News 11 April 2006

Nearly six years later, the Southampton University Hospitals NHS Trust (SUHT) has been fined £100,000 for admitting it did not adequately supervise junior doctors in the trauma and orthopaedic department in June 2000.

Two of them - Dr A [edited] and Dr R [edited] - were convicted of Mr P's [edited] manslaughter due to gross negligence in April 2003 - and given 18 month suspended sentences.


The prosecution also said that if the hospital had organised daily ward round visits by a specialist registrar the chances of Mr P's [edited] condition being missed would have been lessened.

There were also issues regarding why nurses treating Patient P [edited] did not contact senior medical staff.


And BBC News has learned that the hospital trust never checked the previous employment reference of Dr A [edited].

Professor Allan Skirving, of the Royal Perth Hospital in Western Australia, said: "They [SUHT] never made any contact... we would not have given him a good reference.

"It became apparent within a brief period that he was not able to do anything independently."


Hospital trust prosecuted for not supervising junior doctors - BMJ
Hospital fined £100,000 for patient death - The Times, 12 April 2006

Now, not to draw any parallels to the "Dr Death" business in Queensland (more info), but this is the outcome of the aggressive poaching of medical (and nursing) staff from one country to another. All sorts of things can go wrong.
  1. The "donor" country loses its health workforce, after investing a great deal in their training.
  2. The "recipient" country finds it very difficult to ensure that staff meet adequate standards.
  3. A (very) small number of incompetent health-care workers make use of this back-and-forth poaching to hide their tainted history.

I am not opposed to doctors moving around the world - after all, we live in a world of global trading. Some form of international recognition goes a long way towards maintaining international standards and professional parity. Perhaps it is a shame, though, that doctors are being viewed as a commodity, rather than people. I am not suggesting that I know how to fix this, as I am sure that governments of many nations have extensive independent expert advisory panels to do so, but if anything, this is a symptom of our inability to adequately train medical staff.

Unfortunately, as I recently pointed out to some colleagues, there are no such things as Key Performance Indicators for medical education or training. Hospitals and Universities do not get penalised for turning out substandard doctors or specialists. Producing and training quality medical staff does not generate a profit. Screwing the system at every available opportunity is what improves the bottom line. Unfortunately, there is only so much of the system left to screw.

Tuesday, February 27, 2007

It's Official: Senseless Killing Saves Lives

Apologies for the hiatus since the last post. I have just been through a period of great change, and more is yet to come. In the meantime, I couldn't let this one go. In the latest issue of the Archives of Surgery is this article suggesting that video games enhance performance on laparoscopic trainers.

I guess that means that all those hours spent playing Ghost Recon, Rainbow Six, and The Sims are paying off? (I must say, however, that having worked long hours and not having much of a social life for the last decade I have learnt a great deal about how other people live, or at least how Americans think that other people live, based on The Sims).

Now you know why I've been so quiet for the last few months... I've been brushing up my hand-eye co-ordination skills into the wee hours of the night. I'm still trying to work out whether buying an XBOX 360 or a PS3 would be tax-deductible.