Just a Routine Operation

Today we watched this video entitled 'Just a Routine Operation' as part of our simulation training. Simulation training is an opportunity for people at various levels (students or otherwise) in different healthcare professions to run through simulated scenarios as they would in real life but within a protected environment. They often involve what are essentially high-tech dummies that can blink, breathe and have heart sounds-among other things! And everything is done in real time.

The video is about a man who lost his wife because of the shortsightedness of the doctors who were preparing her for a routine operation on her sinuses. He questioned why there wasn't more awareness in the medical profession of how factors other than knowledge and clinical skill can affect patient outcomes; and likened it to his own profession (aviation) where simulated exercises are a core part of training- not an add on.

This made me very uncomfortable and I guess part of it is because we all have this belief that doctors are never directly responsible for the death of patients. Rather, patients happen to die while in the care of doctors- unless neglect or malicious intent is involved. So to draw such a direct causative link assaults our assumptions. Especially one that isn't a statistic but a story.

All the doctors involved were questioned regarding their decision making processes that day. He then went on to say something that completely stopped me in my tracks: They all eventually returned to work and that's exactly what he wanted. Now they are better clinicians and can take the lessons they learnt back into the hospital to improve patient care.

Doctors who make mistakes are often deemed failures by the media and our conscience demands they face serious consequences. That usually means they are struck off the register, destined to live the rest of their days in shame. But we all make mistakes. It just so happens they don't all result in the death of another person. Perhaps this guy is on to something. Maybe he's crazy? Maybe he has grasped an understanding of forgiveness that transcends the mind? Or maybe the answer really isn't to punish those who make mistakes and make them the scapegoats for all of society's injustices?

Should doctors who have fallen from grace be an example, rather than a spectacle? Perhaps the answer lies in rehabilitation, not humiliation.

Yes patients can be rude too

The customer is always right. Right? Maybe. Such a sense of entitlement is only heightened by the fact that the 'customers' of the National Health Service (NHS- the body which provides public healthcare in the UK) are largely taxpayers who quite rightly expect their money's worth.

Sorry to disappoint those who thought this was going to be a rant full of juicy gossip fresh from the bedside. I would prefer not to be stripped of my GMC (General Medical Council) number before I get a chance to properly use it. People with power to do that tend not to look kindly on those who break patient confidentiality. However, I would like to draw on some of the negative experiences I have had with patients and their families to share with you some of the sentiments of those on the receiving end of hard criticism and raw emotion.

Now don't get me wrong. I do not mean to be overly critical of the patient population. Many a patient has let me stick them with needles when I barely knew how to open the packet and stick my gloved fingers in places which, under ordinary circumstances, would not be appropriate for a person you have just met to expose- and often with a flippant "Well you've got to learn sometime haven't you!" For this, I am exceedingly grateful. Those willing souls have either knowingly or unknowingly contributed to building my skill set and my confidence. They have also ultimately contributed to building a better NHS full of competent future doctors.

What these slightly grandiose statements are trying to convey is that medical students are just that: students. Students for whom the majority of their learning takes place in a high-stress environment: between nurses taking a temperature and doctors rattling off numbers down a phone. Patients and their relatives are under their own stresses: between a new diagnosis of cancer and an Xray that was supposed to be done 2 hours ago. In this setting sparks fly easily and the one to get the brunt of the force can sometimes be the poor medical student who has just conveniently appeared to take the 5th blood test for the day.

Patients have said some unkind things to me out of frustration that I'm sure they would not have said had the circumstances been different. At the end of the day, you get paid to be their punching bag (within reason as assault is not appropriate) and that requires depth of understanding and empathy. Often I wonder what my response would have been had I walked a mile in their shoes....

However, it so happens that patients' most vulnerable moments are often my greatest learning opportunities- to grow as a clinician and to grow in compassion.

I've got to learn sometime haven't I?