Split Thread Do Doctors cover for each other's misconduct? (Split from "Wakefield")

[MattusMaximus]

Conspiracy mongering about Big Pharma and Big Medicine in 3... 2... 1...

 

[Ivor the Engineer]

Today's GMC verdict was also a 10-year-old case. The doctor was not struck off. People are outraged and declare that it's all just an old boys' club that protects its members....

Rolfe.

...which it is. Perhaps they believe doctors can't stack shelves or work on the checkout of a supermarket if they get struck off for being lethally incompetent physicians.

http://news.bbc.co.uk/1/hi/england/hampshire/8486936.stm

Misconduct doctor Jane Barton escapes being struck off

A doctor who prescribed "potentially hazardous" levels of drugs to elderly patients who later died has escaped being struck off.

Dr Jane Barton will be allowed to continue working under certain conditions despite being found guilty of serious professional misconduct.

She was accused of a series of failings in her care of 12 patients at Gosport War Memorial Hospital in the 1990s.

Relatives and the General Medical Council criticised the panel's ruling.

Family members of those who had died shouted at the fitness to practise panel when the decision was delivered in central London.

Iain Wilson, the son of Robert Wilson, one of the patients who died, shouted: "You should hang your head in shame."

The panel had previously heard that elderly patients were left in "drug-induced comas" after being over-prescribed painkillers and sedatives.

...

 

[Ivor the Engineer]

you know, i clicked on your link expecting a link to another thread....only to be taken a mouse scroll away

i'd have thought the GMC would have been keen to ditch and disown Wakefield ASAP years ago. But maybe it is "all doctors together" (even the really crappy ones..)

I bet most doctors have hurt or hastened the death of some of their patients in the past and not been found out. So when one of their peers is brought to book for doing something they can imagine doing or have done themselves, it's not unexpected that they go easy on them.

 

[Silly Green Monkey]

I bet most doctors have hurt or hastened the death of some of their patients in the past and not been found out. So when one of their peers is brought to book for doing something they can imagine doing or have done themselves, it's not unexpected that they go easy on them.

That's an incredibly serious allegation, have you a shred of evidence to back up your insulting claim of criminal behavior on the part of doctors worldwide?

 

[Kevin_Lowe]

That's an incredibly serious allegation, have you a shred of evidence to back up your insulting claim of criminal behavior on the part of doctors worldwide?

I see you haven't met Ivor before.

 

[Ivor the Engineer]

That's an incredibly serious allegation, have you a shred of evidence to back up your insulting claim of criminal behavior on the part of doctors worldwide?

http://www.nap.edu/openbook.php?record_id=9728&page=26

2— Errors in Health Care: A Leading Cause of Death and Injury

Health care is not as safe as it should be. A substantial body of evidence points to medical errors as a leading cause of death and injury.

• Sizable numbers of Americans are harmed as a result of medical errors. Two studies of large samples of hospital admissions, one in New York using 1984 data and another in Colorado and Utah using 1992 data, found that the proportion of hospital admissions experiencing an adverse event, defined as injuries caused by medical management, were 2.9 and 3.7 percent,1 respectively. The proportion of adverse events attributable to errors (i.e., preventable adverse events) was 58 percent in New York, and 53 percent in Colorado and Utah.2

• Preventable adverse events are a leading cause of death in the United States. When extrapolated to the over 33.6 million admi ssions to U.S. hospitals in 1997, the results of these two studies imply that at least 44,000 and perhaps as many as 98,000 Americans die in hospitals each year as a result of medical errors.3 Even when using the lower estimate, deaths in hospitals due to preventable adverse events exceed the number attributable to the 8th-leading cause of death.4 Deaths due to preventable adverse events exceed the deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).5

• Total national costs (lost income, lost household production, disability, health care costs) are estimated to be between $37.6 billion and $50 billion for adverse events and between $17 billion and $29 billion for preventable adverse events.6 Health care costs account for over one-half of the total costs. Even when using the lower estimates, the total national costs associated with adverse events and preventable adverse events represent approximately 4 percent and 2 percent, respectively, of national health expenditures in 1996.7 In 1992, the direct and indirect costs of adverse events were slightly higher than the direct and indirect costs of caring for people with HIV and ADS.8

• In terms of lives lost, patient safety is as important an issue as worker safety. Although more than 6,000 Americans die from workplace injuries every year,9,10 in 1993 medication errors are estimated to have accounted for about 7,000 deaths.11 Medication errors account for one out of 131 outpatient deaths and one out of 854 inpatient deaths.

• Medication-related errors occur frequently in hospitals; not all result in actual harm, but those that do are costly. One recent study conducted at two prestigious teaching hospitals found that almost two percent of admissions experienced a preventable adverse drug event, resulting in average increased hospital costs of $4,700 per admission or about $2.8 million annually for a 700-bed teaching hospital.12 If these findings are generalizable, the increased hospital costs alone of preventable adverse drug events affecting inpatients are about $2 billion for the nation as a whole.

• Hospital patients represent only a fraction of the total population at risk of experiencing a medication-related error. In 1998, nearly 2.5 billion prescriptions were dispensed by U.S. pharmacies at a cost of about $92 billion.13 Numerous studies document errors in prescribing medications,14,15 dispensing by pharmacists,16 and unintentional nonadherence on the part of the patient.17 Medication errors have the potential to increase as a major contributor to avoidable morbidity and mortality as new medications are introduced for a wider range of indications.

I'm also reading a couple of books by Atul Gawande: Complications and Better.

Doctors, like everybody else, learn by making mistakes. In general they should not be penalised for making them. However, when they don't appear to be learning from a series of mistakes they should be stopped from practicing medicine.

 

[Mojo]

Doctors, like everybody else, learn by making mistakes. In general they should not be penalised for making them. However, when they don't appear to be learning from a series of mistakes they should be stopped from practicing medicine.

You need more than just evidence of the prevalence of medical errors to support your contention that "most doctors have hurt or hastened the death of some of their patients" as a result of misconduct (you are evidently not talking about just "making mistakes" because it is in the context of a doctor who has been found guilty of serious professional misconduct, and you claim that this doctor has been "brought to book for doing something they can imagine doing or have done themselves").

You need to establish that most doctors have hurt or killed their patients as a result of misconduct.

 

[Ivor the Engineer]

You need more than just evidence of the prevalence of medical errors to support your contention that "most doctors have hurt or hastened the death of some of their patients" as a result of misconduct (you are evidently not talking about just "making mistakes" because it is in the context of a doctor who has been found guilty of serious professional misconduct, and you claim that this doctor has been "brought to book for doing something they can imagine doing or have done themselves").

You need to establish that most doctors have hurt or killed their patients as a result of misconduct.

Errors made by a doctor while he or she was deprived of sleep would be misconduct.

http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0030487

Background

A recent randomized controlled trial in critical-care units revealed that the elimination of extended-duration work shifts (≥24 h) reduces the rates of significant medical errors and polysomnographically recorded attentional failures. This raised the concern that the extended-duration shifts commonly worked by interns may contribute to the risk of medical errors being made, and perhaps to the risk of adverse events more generally. Our current study assessed whether extended-duration shifts worked by interns are associated with significant medical errors, adverse events, and attentional failures in a diverse population of interns across the United States.


Methods and Findings

We conducted a Web-based survey, across the United States, in which 2,737 residents in their first postgraduate year (interns) completed 17,003 monthly reports. The association between the number of extended-duration shifts worked in the month and the reporting of significant medical errors, preventable adverse events, and attentional failures was assessed using a case-crossover analysis in which each intern acted as his/her own control. Compared to months in which no extended-duration shifts were worked, during months in which between one and four extended-duration shifts and five or more extended-duration shifts were worked, the odds ratios of reporting at least one fatigue-related significant medical error were 3.5 (95% confidence interval [CI], 3.3–3.7) and 7.5 (95% CI, 7.2–7.8), respectively. The respective odds ratios for fatigue-related preventable adverse events, 8.7 (95% CI, 3.4–22) and 7.0 (95% CI, 4.3–11), were also increased. Interns working five or more extended-duration shifts per month reported more attentional failures during lectures, rounds, and clinical activities, including surgery and reported 300% more fatigue-related preventable adverse events resulting in a fatality.


Conclusions

In our survey, extended-duration work shifts were associated with an increased risk of significant medical errors, adverse events, and attentional failures in interns across the United States. These results have important public policy implications for postgraduate medical education.

 

[Silly Green Monkey]

So are you amending your statement to refer specifically to hospital doctors in the United States?

 

[Ivor the Engineer]

So are you amending your statement to refer specifically to hospital doctors in the United States?

No. The US studies are applicable to physicians in other countries as well.

 

[Criticalist]

How is an error made by a doctor while deprived of sleep misconduct? The residents in the survey you linked to don't decide the lengths of their own shifts - that is determined by the hospital adminstrators. There is no facility to say "I'm a bit tired and am going for a nap - call someone else for the next hour or two". Maybe there should be - but that is not the fault of the doctors you are accusing of misconduct.

 

[Ivor the Engineer]

How is an error made by a doctor while deprived of sleep misconduct? The residents in the survey you linked to don't decide the lengths of their own shifts - that is determined by the hospital adminstrators. There is no facility to say "I'm a bit tired and am going for a nap - call someone else for the next hour or two". Maybe there should be - but that is not the fault of the doctors you are accusing of misconduct.

I agree with you up to a point. However, physicians have been going along with the practise of working long shifts while knowing that the resulting tiredness can seriously impair their performance and put their patients' health and lives at risk for decades. While the excuse 'I was just following orders' is understandable, it is not a valid defence.

 

[Criticalist]

I agree with you up to a point. However, physicians have been going along with the practise of working long shifts while knowing that the resulting tiredness can seriously impair their performance and put their patients' health and lives at risk for decades. While the excuse 'I was just following orders' is understandable, it is not a valid defence.

I don't think its that simple. For example, I am on call tonight. I may get no calls, and spend the night undisturbed in bed or,within the next few moments I may have to go into the hospital and spend the night there. If that happens I will have had no sleep for 24 hours. According to you, I am currently guilty of misconduct, as I have put myself into a position where I may have to take clinical decisions while fatigued.

 

[Ivor the Engineer]

I don't think its that simple. For example, I am on call tonight. I may get no calls, and spend the night undisturbed in bed or,within the next few moments I may have to go into the hospital and spend the night there. If that happens I will have had no sleep for 24 hours. According to you, I am currently guilty of misconduct, as I have put myself into a position where I may have to take clinical decisions while fatigued.

Have you brought it to your supervisor's/manager's/colleagues' attention that you are sometimes making clinical decisions while deprived of sleep and there is evidence to suggest doing so dramatically increases the probability you will make a mistake? If so what do they say?

Is the rationalisation used that it's better to be seen by a sleep deprived doctor than no doctor at all?

 

[Criticalist]

Have you brought it to your supervisor's/manager's/colleagues' attention that you are sometimes making clinical decisions while deprived of sleep and there is evidence to suggest doing so dramatically increases the probability you will make a mistake? If so what do they say?

Is the rationalisation used that it's better to be seen by a sleep deprived doctor than no doctor at all?

I'm describing a situation that applies to nearly every doctor that covers acute patient care. Occasions will arise when we will have to treat patients when fatigued. Are we all guilty of negligence? Is the whole profession culpable - or should we just accuse the doctors who make mistakes.
Please note I am not arguing that doctors hours and working schedules should not be designed to prevent fatigue as much as possible. What I am questioning is your suggestion that individual doctors should be accused of misconduct if they make an error when sleep deprived. If you accept that, then any doctor who is in a position where they might treat a patient when fatigued, whether or not they make an error, is guilty of misconduct. If I go to work drunk, whether I make a mistake or not, I am guilty of misconduct. If I am on call for a 24 hour shift, I know I am going to be tired at the end. I am behaving improperly just by turning up.

 

[Ivor the Engineer]

I'm describing a situation that applies to nearly every doctor that covers acute patient care. Occasions will arise when we will have to treat patients when fatigued. Are we all guilty of negligence? Is the whole profession culpable - or should we just accuse the doctors who make mistakes.
Please note I am not arguing that doctors hours and working schedules should not be designed to prevent fatigue as much as possible. What I am questioning is your suggestion that individual doctors should be accused of misconduct if they make an error when sleep deprived. If you accept that, then any doctor who is in a position where they might treat a patient when fatigued, whether or not they make an error, is guilty of misconduct. If I go to work drunk, whether I make a mistake or not, I am guilty of misconduct. If I am on call for a 24 hour shift, I know I am going to be tired at the end. I am behaving improperly just by turning up.

Why are doctors on call for 24 hour shifts? Except for issues regarding continuity of care, why can't doctors work overlapping 14 hour shifts?

 

[Darat]

I don't think its that simple. For example, I am on call tonight. I may get no calls, and spend the night undisturbed in bed or,within the next few moments I may have to go into the hospital and spend the night there. If that happens I will have had no sleep for 24 hours. According to you, I am currently guilty of misconduct, as I have put myself into a position where I may have to take clinical decisions while fatigued.

I've had to pull all-nighters in my own job over the years and I know for a fact I am not as effective, as on the ball etc. after working for 24 hours hours straight. If I was working in an environment in which my decisions could directly result in harm to someone else (or indeed even death) there is no way I would consider myself fit to do my job after 24 hours, to do so would to me seem to be the very definition of "negligence".

_______________

To the wider point of covering-up, (anecdote alert!!!) my personal experience is that it is an institutionalised reaction for medical staff to cover-up for each other.

 

[paximperium]

I've had to pull all-nighters in my own job over the years and I know for a fact I am not as effective, as on the ball etc. after working for 24 hours hours straight. If I was working in an environment in which my decisions could directly result in harm to someone else (or indeed even death) there is no way I would consider myself fit to do my job after 24 hours, to do so would to me seem to be the very definition of "negligence".

Which is more negligent? A sleepy on-call doc or no doc at all?

 

[Ivor the Engineer]

Which is more negligent? A sleepy on-call doc or no doc at all?

Thank you for answering my question:

Is the rationalisation used that it's better to be seen by a sleep deprived doctor than no doctor at all?

ETA: Which is more negligent? A sleepy airline pilot or no pilot at all?

 

[Darat]

Which is more negligent? A sleepy on-call doc or no doc at all?

A non-existent doctor can't kill me by her non-actions!