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.