Saturday, 18 October 2014

How An Engineer designed his own insides and saved his own Life - Ultimate Shared Care

Amazing story. Patient deciding and designing his own treatment is the purest of all shared care decision making. 

Patient Centredness, Ethics and Why You can' have them.

Two articles in a recent issue of the British Medical Journal illustrate different ways hospitals and healthcare institutions can introduce interventions to improve patient outcomes. The need for a response to poor cardiac surgery outcomes in one hospital in the Netherlands proved to be the impetus to radically change the way the institute and its employees deals with patients is described in the first.

Saturday, 27 September 2014

The Effect of Feminisation of Medical Training

As honorary senior lecturer at the University of Sheffield,  I am often involved in the assessment and examination of medical students.
I was recently attending a refresher course on OSCE (Observed Structured Clinical Examination) assessment of medical undergraduates.  This formal instruction for examiners is, we were told, now mandated by the General Medical Council .
The talk together with demonstration videos of how to and how not to carry out a proper valid OSCE assessment was very helpful and informative.
The speaker was a medical education specialist from the medical school. Many of her senior colleagues are also women. It struck me as I listened to her presentation that, in addition to a steep increase in the number of female medical graduates, there has been a gradual feminisation of medical training in the UK. I suppose that this should hold no surprise to anyone as the number of academic medical women involved in designing curricula and assessments has inevitably increased. This, I hasten to add,  is no bad thing. On the contrary, it is to be welcomed. Feminisation of undergraduate medical training has led to an increase in patient centredness of what is expected from modern doctors  (what old timers used to call the touchy feely bits!) - a quality hitherto lacking in medical training.
Whether this approach to medical training occurs in all of the countries of origin of the large numbers of foreign graduates who work in the NHS is debatable. This should be a matter of some concern if the predominance of foreign born doctors who fall foul of the General Medical Council is to be reversed. There is no doubt that this new approach to undergraduate training is extended into postgraduate training and foreign graduates who come to the UK for their postgraduate training learn fast. The doctors who are at risk are those who do all their training elsewhere and come to the UK for their tenured job. It is this group who require an intensive and prolonged induction prior to entering medical life in the UK with all that British society expects from its doctors.

Saturday, 20 September 2014

High Fidelity Surgical Training

This is an excellent example of high fidelity simulation of a difficult surgical procedure.
As one surgeon in the video says it is now unacceptable for a surgeon to go through a learning curve whilst operating on patients. A smart device like this not only recreates the procedure but cleverly, is able to give feedback to the surgeon.
Much more of this is required. Surgeons are clever and resourceful. Colleges of surgeons should be encouraging and incentivising young surgeons to do what this clever chap from Holland has achieved.

Friday, 29 August 2014

The Problem with a growing Complaints System

The fact that the number of complaints in the English National Health Service has risen sharply should not surprise anyone. After years of terrible headline stories about Midstaffs, and other institutions followed by the Francis report and Keogh reviews, anything else but a massive increase in complaints would have been an abnormal response from users of the National Health Service. There are many, including victims and relatives of victims of poor practice, who feel that what the NHS needs to get it back on the straight and narrow is such an increase and more.
This rapid increase cannot however be sustained .
Increased complaints and an undoubted  increase in funding for the NHS by whoever is elected next year makes my heart sink.
The expected response from a service that is hooked on process will I fear produce a megamonster  that will eventually strangle its parent and make efficient working increasingly difficult.  This is clearly self defeating and will threaten to produce a service that is less and not more safe.
I am not advocating that complaints should be discouraged or ignored but that the response of the NHS should be smarter. There surely must be good examples out there in the world outside the NHS bubble from whom lessons could be learnt.

Saturday, 7 June 2014

Medical Super Specialisation is good AND bad for patients!

  • This is an interesting article suggesting that if a surgeon specialises in one type of operation and therefore carries out a large number of them per year, his patients are less likely to suffer complications. 
  • In an age when patient outcomes are important, this strengthens the case for further specialisation in different disciplines of surgery. In my specialty, cardiac surgery for example, there are moves now for surgeons just to specialise in surgery of the mitral valve or surgery of the aorta. If I was a patient with mitral valve disease, I know who I would want to operate on my mitral valve . 
  • There are however tensions and problems associated with increasing specialisation.