HEART BEAT:Hospitals used to be havens where the sick were diagnosed and treated, writes Maurice Neligan
NEAR MISSES and adverse events: I thought about such things when reading a frightening list of so- called adverse events reported from hospitals to the State Claims Agency. Hospitals used to be havens where the sick were diagnosed and treated. Now we are told they are dangerous places where you enter at your peril.
I was fortunate in that I practised in different times, before such lists of disasters, putative or real, were published and before the State Claims Agency was established. The intentions in establishing this body were good and were driven by the rising costs of litigation. However, the injunction to report every incident, no matter how trivial that could result in patient injury and possible litigation, has spawned disastrous consequences.
I have said before that bad things happen in just about every aspect of life. This is pithily expressed in the American colloquialism. Hospitals are no exception to this general phenomenon.
Life within the medical world is no smoother than elsewhere. The wrinkles and rough patches in the hospital environment arouse much indignation. Seemingly they are not supposed to happen.
Well they do and always will. Some are preventable and failure to avoid such may indeed be blameworthy. Many occur and it is nobody's fault.
What is reprehensible here is the publication of lists of trivia that may unsettle people already stressed, who are facing a hospital stay. Consider some of the listed items. Slips and falls; are they avoidable in a hospital context? Not any more than in the street or home.
Any increased incidence is accounted for by the fact that the patient population contains many frail and debilitated people. The vast majority of such incidents have no adverse consequences and normally would be of little note. Here, however, they are "adverse events" in those dangerous hospitals. Such depiction is yet another manifestation of the absence of common sense.
Furthermore, the time spent reporting the trivial would be much better employed looking after the patients rather than filing rain forests of useless reports which conceivably could elevate the mundane to litigious levels.
In my intern year the bane of my life was the doleful 2am call: "Mr/Mrs Bloggs has fallen out of bed." Your immediate, but of course repressed, thought was "for Christ's sake put the old bat back in". Instead you rolled out of your warm bed and set off through a dark hospital, knowing well that the patient was seldom seriously hurt.
The incident may have arisen in the first place due to inappropriate night sedation of a confused patient. I use the word inappropriate because it often became so only in retrospect. "It shouldn't have happened. Why didn't the nurses stop it?" "Because there were 24 other patients in the ward with one very sick person taking up most of their time; it was very busy in the ward". You didn't add that the nurses didn't have eyes in the backs of their heads or that they were overworked and underpaid.
All involved did their best for the patient. It was noted in the nurses' report and you wrote a note in the patient chart.
More dramatic sounding in this nonsensical list of medical dereliction were misdiagnoses. I don't think there is doctor anywhere of any experience who hasn't a few misdiagnoses tucked under his belt. Peter Mere Latham, a London physician in the 19th century wrote truly, "the diagnosis of disease is often easy, often difficult, and often impossible". Such is still the case.
The passage of time may be a prerequisite for firm diagnosis; time increasingly denied to the doctors by the heedless rush for a quick bed turnover time. Misdiagnosis or missed diagnosis is rarer now with increased laboratory and radiological capabilities augmenting the essential clinical work and knowledge.
Sometimes, and it happens to all physicians, that their eyes are open but they do not see. The wise doctor in such situations calls in colleagues to review such a case. Diseases are many, often complex and ill understood and patients and what might be loosely described as their "constitutions vary widely". It is indeed a wonder that diagnosis is so often complete.
It is the key to treatment and explains why the great medical schools and hospitals with their interlocking disciplines and departments developed over time. It is for sure and certain that profit-based small hospitals be they co-located or otherwise cannot develop the panoply of technology and experience needed to cover the medical spectrum. We didn't need lists in newspapers to tell us this. We knew only too well.
The silver lining to all this is if you're afraid of all the scary things that happen in hospitals, you can always stay home and save the State a lot of money!
• Maurice Neligan is a cardiac surgeon