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

[paximperium]

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

Uh...yes it can.

Physicians are not about to operate on your gun shot wound/ruptured appendix. Unless there is a surgeon available, you'll have to wait for the chopper to fly in, pick you up and fly you to the trauma center.

 

[Darat]

Uh...yes it can.

...snip...

How does something that doesn't exist carry out any action?

 

[paximperium]

How does something that doesn't exist carry out any action?

Ah, I see your point.

The issue becomes less of an individual act at that point and becomes a more systems issue. I guess it becomes an question of "Is it negligent for the hospital/clinic/medical center to provide a sleepy on-call doc or no doc at all?"

 

[Professor Yaffle]

I wouldn't argue that any individual doctor is negligent in working under these circumstances. However I would argue that the system (and by implication those who perpetuate such a system) which forces doctors to work under such circumstances is negligent.

And unless my reading of Bodies (written by a former doctor) is wildly innacurate, I would also agree that covering up for colleagues is common, but by no means universal. However, once it reaches the level of the GMC, I don't think it is so much a factor.

 

[Darat]

Ah, I see your point.

The issue becomes less of an individual act at that point and becomes a more systems issue. I guess it becomes an question of "Is it negligent for the hospital/clinic/medical center to provide a sleepy on-call doc or no doc at all?"

Which should be a question we answer empirically.

 

[paximperium]

I wouldn't argue that any individual doctor is negligent in working under these circumstances. However I would argue that the system (and by implication those who perpetuate such a system) which forces doctors to work under such circumstances is negligent.

The problem in the US is multifaceted but basically due to a lack of doctors(especially in specific specialities) but also a lifestyle problem. Most docs would rather be on a 24 hour call once a month than three 8hour calls for instance.

There is also a simple issue. No Doc ever has to be on-call. Ever. If you force them to be on-call or to do bad hours, they will just stop doing call.

And unless my reading of Bodies (written by a former doctor) is wildly innacurate, I would also agree that covering up for colleagues is common, but by no means universal. However, once it reaches the level of the GMC, I don't think it is so much a factor.

I agree. There is a general glossing over of mistakes when it comes to colleagues. This is especially true if it is caught by others before it affects the patient or is a relatively harmless mistake.

The big mistakes do but seldome get "covered up".

 

[Finster]

If I go to work drunk, whether I make a mistake or not, I am guilty of misconduct.

Maybe I misunderstood what you're trying to say but I would say yes. How would you feel about the Pilot on your next flight showing up for work drunk?

 

[Professor Yaffle]

An article on the subject by Jed Mercurio (writer of Bodies):

http://www.guardian.co.uk/society/2004/may/18/lifeandhealth.medicineandhealth

 

[Ivor the Engineer]

An article on the subject by Jed Mercurio (writer of Bodies):

http://www.guardian.co.uk/society/2004/may/18/lifeandhealth.medicineandhealth

Turning a blind eye and closing ranks serves well all of us who made the isolated human error and learned from it and became good doctors. I believe that is how it served me and my friend who didn't monitor his patient's potassium. But I have to confess I don't know what kind of doctor the houseman who missed the heart attack became. It is only then that you realise the system that covered for you is the same system that wrongly protected GP Harold Shipman and gynaecologist Rodney Ledward for so many years at so tragic a cost to so many patients. But, because of the blame culture, many doctors remain persuaded that closing ranks and covering up are in their interests, because they still fear that they can be as much victims of medical accidents as their patients.

By going along with a system which allows the same mistakes to happen again and again and again, he believes he and others became good doctors?

 

[Darat]

An article on the subject by Jed Mercurio (writer of Bodies):

http://www.guardian.co.uk/society/2004/may/18/lifeandhealth.medicineandhealth

Well that certainly supports my view that "...To the wider point of covering-up, ..... it is an institutionalised reaction for medical staff to cover-up for each other."

 

[Professor Yaffle]

On the plus side, I note that when my niece was in hospital with her heart problems, she was, at one point, mistakenly given a much larger dose of a drug than she should have been. The mistake caused no lasting problems for her, but the doctor told my sister about the error and asked if she wanted to make a complaint. My sister replied that as long as they looked into why the mistake was made and they made efforts to make sure it didn't happen to someone else, she was happy to leave it at that.

 

[GreyICE]

I'm not saying that there's some 'great conspiracy.' It seems almost natural to me. You know Bob. He's a great guy. Smart doctor, saved many lives. He's been on call, and it's a rough week, he worked 70 or 80 very strange hours.

You find a patient, he's been proscribed something that reacts negatively with another drug he's taking. It's a logical thing to proscribe, but no doctor in their right mind would proscribe it if they're taking this other drug that the patient is taking. You know Bob is doing the best he can, and he's tired. You deal with the complication, assure the patient that it's fine, and it's a natural part of the process, and go on with your life. Maybe you even take Bob aside and tell him about it, off the record.

It seems plausible to me that that incident is frequently repeated. It requires no big conspiracy.

P.S. Darat, that article scares me.

 

[Skeptic Ginger]

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 wouldn't say "most" but the practice is more common than people probably think. A lot of docs prescribe lethal doses of morphine when removing patients from ventilators. Not every one of those patients would be dying without the drug.

OTOH, I don't think 'criminal' is the correct adjective to describe the practice.

Nevermind. I see Ivor had something else in mind.

 

[Skeptic Ginger]

Thank you for answering my question:



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

You seem to think the supply of MDs exceeds demand and there is so much money in the medical system we can pay doctors full salary for their 14 hours of on call time. Otherwise how do they earn a living and cover all that on call time?

 

[Deetee]

Maybe I misunderstood what you're trying to say but I would say yes. How would you feel about the Pilot on your next flight showing up for work drunk?

This has happened.
When it does,the flight is cancelled.

If a doctor decides he is a bit tired (eg having stayed up til 3am watching the late night movie), how would you like him to phone in that next morning saying: "I'm a bit tired to do my shift in A&E today, can you just cancel all emergencies for 8 hours?"

According to Ivor, the doctor is guilty of misconduct if he comes to work knowing he may be performing at less than 100% efficiency due to tiredness.
He would rather the doctor not report for duty, but has given no thought as to the possible ramifications of this action.

 

[Ivor the Engineer]

This has happened.
When it does,the flight is cancelled.

Was the pilot reprimanded?

If a doctor decides he is a bit tired (eg having stayed up til 3am watching the late night movie), how would you like him to phone in that next morning saying: "I'm a bit tired to do my shift in A&E today, can you just cancel all emergencies for 8 hours?"

According to Ivor, the doctor is guilty of misconduct if he comes to work knowing he may be performing at less than 100% efficiency due to tiredness.
He would rather the doctor not report for duty, but has given no thought as to the possible ramifications of this action.

I would rather the doctor be professional enough to have ensured he or she had gotten sufficient rest so as not to be severely sleep deprived in the first place.

 

[Ivor the Engineer]

You seem to think the supply of MDs exceeds demand and there is so much money in the medical system we can pay doctors full salary for their 14 hours of on call time. Otherwise how do they earn a living and cover all that on call time?

How much money would be saved by the reduction in medical errors related to tiredness, which result in both extra healthcare being required and doctors and hospitals being sued?

You live and work in a country which has the most expensive healthcare system in the world and you're worried about not being able to afford to pay for doctors to work reasonable shifts so that they are not deprived of sleep?

 

[paximperium]

You seem to think the supply of MDs exceeds demand and there is so much money in the medical system we can pay doctors full salary for their 14 hours of on call time. Otherwise how do they earn a living and cover all that on call time?

I think it is the best idea ever. Every doc, especially those interns and residents, I know of will be totally for it.

 

[Ivor the Engineer]

I think it is the best idea ever. Every doc, especially those interns and residents, I know of will be totally for it.

Here's what's happening in the UK:

http://www.mmc.nhs.uk/pdf/A guide to the implications of EWTD.pdf

For doctors in training, the reference period is 26 weeks (six months) and so the 48-hour limit applies to an average of the hours over this period. This means that in some weeks it is possible, that a doctor may work more than 48-hours. However, rest requirements must be met for example, 11 hours rest n every 24-hours under EWTD. For other NHS staff, the reference period is 17 weeks, (which effectively represents the four months maximum permitted by Article 16(a) of the Directive). (See legal question on exceptional circumstances and emergencies).

An emergency might mean additional work needs to be undertaken, this could affect the average hours or mean that rest is missed. As additional hours may mean compensatory rest is due, or the doctor’s pay and banding may be affected, employers will have local procedures for authorising and recording additional hours. This is usually through the HR department / medical personnel, clinical manager or supervisor.

There is no strict rule about the hours worked in one day or week under the Working Time Regulations or the New Deal Contract of employment (the national terms and conditions for trainee doctors) should a patient need a doctor’s input or in the event of an emergency. Under EWTD, hours are averaged over six months. New Deal compliance is monitored twice a year, over a two-week representative period by NHS Employers.

 

[Criticalist]

There are a number of different issues here. The regulations than Ivor linked to are commonplace in most of the hospitals in which I have worked. Nobody deliberately rosters trainees or seniors to impossible hours. (This may be different in the US.). Look at the rest of the document:

"An emergency might mean additional work needs to be undertaken, this could affect the average hours or mean that rest is missed."

This is the sort of situation I am describing. If you turn up at 2:00am in the emergency department with a ruptured abdominal aneurysm that needs a cross clamp on in 30 minutes or you will bleed to death what would you prefer: The on call vascular surgeon who has been up all night to take you to theatre, or for her to decline to do so on the basis that, according to Ivor, it would be unprofessional. After all, she should have made sure she wasn't in that position, right?

Well, why not just train more vascular surgeons, and have them on overlapping 14 hour shifts or whatever, so there is always a fresh faced, bright and smiley surgeon ready to jump in at a moments notice and sew your aorta back together before you die? Except the problem here is that the work neccessary to support a fully trained specialist of this nature is not a constant 24 stream of life threatening emergencies. The majority of neccessary work is done in daylight hours elective operating lists and outpatient clinics. The trainees need exposure to that or they won't learn their job. In public systems you can't have fully trained specialists whiling their time away on 12 hours shifts overnight when the majority of the time there will be nothing for them to do. There is neither the money, nor the number of available doctors for them to do such a thing.

Lets go back to our vascular surgeon. What would you have her do? The whole structure of the health service has put her in this position;It is a combination of avaialable training places, government funding, and local volume of vascular surgical referrals that determine the number of surgeons available in her area. She can realistically influence none of these things,and it will be the same in whatever hospital she works in. She is tired, sleep deprived, and unless she takes you to theatre in the next 30 minutes you will die. Ivor thinks if she does so she is being unprofessional, and if she makes an error,should be accused of misconduct.