How many airline pilots perform surgery, diagnose sick people or
prescribe
powerful antibiotics?
"Raymond" <Bluerhymer@[EMAIL PROTECTED]
> wrote in message
news:1ef10b52-5549-4f7a-beec-55032e99d437@[EMAIL PROTECTED]
> "'The person most likely to kill you is not a relative or a friend,
> or
> a mugger or a burglar or a drunken driver. The person most likely to
> kill you is your doctor."
>
> === (Vernon Coleman) author, What Doctors Don't Tell You
>
> Why do doctors kill more people than airline pilots?
> Mistakes are buried - along with the patients -
> How can it be made safer?
> By Dr Phil Hammond
>
> Last updated at 7:54 AM on 05th August 2008
>
> Each year thousands of hospital patients die as a result of human
> error. In a new Radio 4 programme GP Phil Hammond -who exposed the
> Bristol babies heart scandal in the 1990s - examines whether enough
> is
> being done to protect us.
>
> Dr Phil Hammond: Questions who is to blame when patients die
> The late Dr Tom Chalmers, a distinguished medical researcher, once
> asked why doctors kill more people than airline pilots.
>
> The odds of dying in hospital as a result of human error are 33,000
> times greater than the risk of dying in an air crash - an
> extraordinary figure, especially as most people are more scared of
> flying.
>
> Dr Chalmers came up with a number of reasons for this apparent
> discrepancy - such as the requirement that pilots take time off for
> sleep, undergo random breath-testing and that their skills are
> tested
> every six months.
>
> But he saved his harshest comment until last: 'If doctors died with
> their patients, they'd take a great deal more care.'
>
> Most doctors bristle at the suggestion that they don't take patient
> safety seriously enough. After all, medicine is more complicated
> than
> aviation and it's impossible always to get it right. Even the best
> doctors make mistakes.
>
> Errors happen either because we do the wrong thing (make the wrong
> diagnosis or give the wrong drug) or we do the right thing wrong.
>
> Often, we blame 'the system' for causing errors - the lack of
> manpower
> that leaves exhausted and inexperienced staff without supervision -
> but errors can happen in ideal cir***stances.
>
> Take the story of Elaine Bromiley. Elaine was 37 when she was booked
> in for routine sinus surgery under general anaesthetic. Her
> anaesthetist had been a consultant for 16 years, her ENT surgeon had
> 30 years under his belt. The theatre was well equipped and there
> were
> no emergencies elsewhere.
>
> As her husband Martin observed: 'This was a dream scenario for
> safety;
> a senior surgical team working undisturbed in state-of-the-art
> surroundings.'
>
> And yet Elaine's anaesthetic went tragically wrong and repeated
> attempts to ventilate or to intubate - pass a tube into her airway -
> failed.
>
> 'Can't intubate, can't ventilate' is a rare but recognised
> emergency,
> which requires an emergency tracheotomy, cutting a hole in the
> throat
> to pass the tube through.
>
> However, the consultants decided to keep attempting to intubate,
> finally abandoning the procedure hoping that Elaine would wake up.
> She
> never regained consciousness and died 13 days later.
>
> Martin Bromiley was initially told that his wife's death was bad
> luck.
> But as a pilot, used to analysing critical incidents, he wanted to
> hear the results of the ensuing inquiry.
>
> Bromiley insisted on an independent review which concluded that,
> given
> the experience of the surgeons, it should have been possible to
> follow
> the emergency protocol and perform a tracheotomy. So why didn't it
> happen?
>
> Surgery safety: Deaths can occur during routine operations due to
> human error
>
> Errors happen not just because of lack of skill or knowledge but for
> behavioural reasons. Put someone in an extremely stressful situation
> and even the most senior clinicians can lose the plot.
>
> The role of these human factors in error is well recognised in
> aviation and Bromiley recently founded a charity to help health
> professionals make better decisions under pressure.
>
> What is needed is a team culture where even the most junior member
> of
> staff can raise concerns.
>
> Bromiley's inspirational approach -wanting us to learn from his
> wife's
> death - contrasts with my aggressive exposure of medical scandals.
>
> In 1992, I published confidential audit figures from Bristol Royal
> Infirmary showing that its results for complex heart surgery on
> children were very poor.
>
> The Department of Health knew about the results in 1988 but didn't
> step in until 1995.
>
> I thought my articles would at least spark an investigation, but the
> surgeons carried on for another three years until the death toll was
> too high to ignore.
>
> A subsequent public inquiry concluded that, between 1991 and 1995,
> as
> many as 35 children under the age of one died who would not have
> done
> if they'd been treated elsewhere.
>
> The surgeons were enraged at having their audit figures published.
> They didn't stop and reflect. They adopted a siege mentality and
> carried on regardless.
>
> Defensiveness was culturally ingrained. I trained during the days
> when
> junior doctors clocked up 120 hours some weeks. The NHS paid lip
> service to safety and junior surgeons were often left to perform
> complex operations for the first time alone.
>
> Mistakes were buried - along with the patients - and you muddled
> along
> doing your best. There were huge variations in quality and thousands
> of avoidable errors across the whole of the NHS.
>
> It took the Bristol Inquiry to force politicians and the medical
> establishment to take safety seriously. This sparked a sea change in
> accountability, including the setting up of the National Patient
> Safety Agency to monitor and learn from errors.
>
> But has all this made the NHS safer? In parts, yes. Bristol has
> become
> one of the safest places to have heart surgery. And the publication
> of
> outcomes for heart surgery across the NHS has coincided with a
> reduction in death rates.
>
> But doctors in other specialties have been slow to open themselves
> up
> to scrutiny. As a result, patients aren't as safe as they should be.
>
> How can it be made safer? During the making of the Radio 4
> do***entary, all the NHS staff I spoke to were passionate about
> patient safety, but said a culture of blame and exposure was its
> enemy.
>
> Errors will inevitably occur, but what staff need to prevent these
> happening again is time and sup****t to understand and learn from
> them.
>
> Learn from near misses
>
> This approach doesn't excuse negligence - but often disasters happen
> because of a chain of contributory factors, rather than the single
> action of one person.
>
> One of the pioneers of a more open approach is the surgeon (and
> Health
> Minister) Lord Darzi.
>
> Ten years ago, Darzi decided to introduce a black box in his
> operating
> theatre at St Mary's Hospital, London. This recorded the patients'
> vital signs, the anaesthetic procedures and, contentiously, the
> surgical team, on video, as it went about its business.
>
> Initially, he too struggled against the defensive culture: within 24
> hours, someone had put bin liners over his cameras. But the black
> box
> remains.
>
> His colleagues now realise that the recorded information allows them
> to learn from near misses so tragedies are avoided.
>
> Darzi has also developed a simulated operating theatre that teaches
> his team to manage common distractions (e.g. constant interruptions
> during surgery) and rare, life-threatening emergencies.
>
> Pilots are legally obliged to spend 16 hours a year in a simulator,
> proving their competence, but for surgeons and anaesthetists, it is
> still optional.
>
> Darzi is also helping to pioneer a surgical checklist with the World
> Health Organisation to ensure patients are given the appropriate
> drugs
> and that everyone is prepared for what might go wrong.
>
> This also encourages staff to speak up. However, for the NHS to
> embrace safety requires the political recognition that it's not
> about
> waiting lists and how quickly you get treated that matters, but how
> safely.
>
> Safe staff re****t more errors
>
> One in ten patients admitted to an NHS hospital is accidentally
> harmed
> - and for one in 300 patients, medical error results in death - yet
> still not everyone accepts change.
>
> Some doctors think checklists reduce them to factory workers, others
> have a tantrum if someone reminds them to wash their hands. Safe
> hospitals tend to be calm ones, where everyone accepts feedback and
> works in a team.
>
> Safe staff also tend to re****t more errors. The hospital that admits
> to nothing generally has the most to hide.
>
> So can patients do anything? In America, the error rate is lower
> than
> in the UK. Doctors, ever wary of litigation, take safety seriously
> and
> patients join in.
>
> There, patients are encouraged to ask about a surgeon's training and
> success rates, query medication, insist on hand wa****ng and ensure
> the
> nurse has read their ID bracelet.
>
> In the UK, we lie back and take it. It's far easier to trust
> professionals. I've never met anyone who knocks on the cockpit and
> asks the pilot how often he's landed the plane - you assume he's
> competent, because he's still alive.
>
> If Darzi gets his way, one day we may be able to take safety in the
> NHS as a given. But not yet. So keep your eyes peeled and keep
> asking
> questions.
>
> TO ERR IS HUMAN is on Radio 4 on Monday, August 11, at 9pm.
>
http://www.dailymail.co.uk/health/article-1041663/Why-doctors-kill-people-airline-pilots.html
>
> IN AMERICA: The American people do not enjoy good health, compared
> with their counterparts in the industrialized nations......Even more
> significantly, the medical system has played a large role in
> undermining the health of Americans. According to several research
> studies in the last decade, a total of 225,000 Americans per year
> have
> died as a result of their medical treatments:
>
> http://www.health-care-reform.net/causedeath.htm
> http://www.whale.to/a/smith25.html
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