Dr James Le Fanu: 9 August
There are more than enough reasons why things can go wrong in hospital, or at least not as right as they might. The standard response, almost invariably, is to blame inadequate resources, too few doctors or nurses and so on. But the reverse also applies where ‘de ciencies of care’ are due not to there being too few doctors and nurses, but too many – with no one in charge to make sense of what is going on.
To clarify: back in the 1970s, a general hospital had about 50 consultants on its staff covering the major specialties of surgery, medicine, anaesthesia and so on. Each would have his, or her, own fiefdom; their own ward with their own patients and their own junior and medical nursing staff. No question about who was in charge there.
Now, 30 years on, the number of consultants has increased threefold while, in addition, each is now part of a ‘multidisciplinary team’ composed of nurse specialists, ancillary sta and researchers.
Thus, theoretically, today’s patients benefit first because their consultant’s skills are more specialised and second, from the shared experience of the ‘team’. But the fate of a woman who passed through the hands of no fewer than six teams in less than a year, as described in the British Medical Journal, illustrates the substantial hazards of this new arrangement.
The woman, in her 70s, was described as being fully independent, although suffering from depression, for which she was taking lithium, warranting her first hospital admission with signs of toxicity. This was treated simply enough by reducing her dose, but during her brief stay no one noticed, or acted on, her blood tests that showed her kidneys were not working properly, nor a small tumour in her breast.
A couple of months later, she discovered the tumour herself, leading to a second admission, during which it was removed. But again, no one noticed her now deteriorating kidney function. She was also found to be anaemic, for which she was seen by the gut specialists lest it be due to bleeding from her gut. They found nothing abnormal and no further steps were taken to elucidate the cause of her anaemia.
Nine months later, it all became clear when she was admitted for a third time, by now in severe kidney failure caused by a mass in her pelvis that was obstructing the flow of urine into the bladder. She was referred to yet another team, this time of gynaecologists who took a biopsy and sent it to the laboratory. It was only by chance that, three weeks later, a doctor, flipping through her notes, found the mass to be a large secondary deposit from her original breast cancer. She died shortly afterwards.
Doctors, like anyone else, can make mistakes and it is, of course, easy to be wise after the event. But with each of the six multidisciplinary teams dealing with this unfortunate woman’s problems in isolation from each other, this is clearly a failure not of individuals, but of the ‘system’.
It is difficult to know how to combat this, although the family doctor, medicine’s last remaining generalist, can be a useful ally when it comes to making sense of what is (or is not) going on.
Email drjames@lady.co.uk
‘The rate of success is around 80 to 90 per cent. A godsend,’ she writes. By contrast, another reader, from Dundee, reports that her husband has found that applying a cube of ice to the area above the left eye on the side of the migraine headache is similarly effective.
To clarify: back in the 1970s, a general hospital had about 50 consultants on its staff covering the major specialties of surgery, medicine, anaesthesia and so on. Each would have his, or her, own fiefdom; their own ward with their own patients and their own junior and medical nursing staff. No question about who was in charge there.
Now, 30 years on, the number of consultants has increased threefold while, in addition, each is now part of a ‘multidisciplinary team’ composed of nurse specialists, ancillary sta and researchers.
Thus, theoretically, today’s patients benefit first because their consultant’s skills are more specialised and second, from the shared experience of the ‘team’. But the fate of a woman who passed through the hands of no fewer than six teams in less than a year, as described in the British Medical Journal, illustrates the substantial hazards of this new arrangement.
The woman, in her 70s, was described as being fully independent, although suffering from depression, for which she was taking lithium, warranting her first hospital admission with signs of toxicity. This was treated simply enough by reducing her dose, but during her brief stay no one noticed, or acted on, her blood tests that showed her kidneys were not working properly, nor a small tumour in her breast.
A couple of months later, she discovered the tumour herself, leading to a second admission, during which it was removed. But again, no one noticed her now deteriorating kidney function. She was also found to be anaemic, for which she was seen by the gut specialists lest it be due to bleeding from her gut. They found nothing abnormal and no further steps were taken to elucidate the cause of her anaemia.
Nine months later, it all became clear when she was admitted for a third time, by now in severe kidney failure caused by a mass in her pelvis that was obstructing the flow of urine into the bladder. She was referred to yet another team, this time of gynaecologists who took a biopsy and sent it to the laboratory. It was only by chance that, three weeks later, a doctor, flipping through her notes, found the mass to be a large secondary deposit from her original breast cancer. She died shortly afterwards.
Doctors, like anyone else, can make mistakes and it is, of course, easy to be wise after the event. But with each of the six multidisciplinary teams dealing with this unfortunate woman’s problems in isolation from each other, this is clearly a failure not of individuals, but of the ‘system’.
It is difficult to know how to combat this, although the family doctor, medicine’s last remaining generalist, can be a useful ally when it comes to making sense of what is (or is not) going on.
Email drjames@lady.co.uk
STOPPING MIGRAINE IN ITS TRACKS
Migraine is a most quixotic illness not least in being preventable by a range of sometimes quite contradictory remedies. Thus a reader from Nottinghamshire, whose migraines were described as ‘intractable’ by her consultant, eventually found her attacks could be nipped in the bud by drinking a hot cup of tea with three teaspoonfuls of sugar (which she normally does not use).‘The rate of success is around 80 to 90 per cent. A godsend,’ she writes. By contrast, another reader, from Dundee, reports that her husband has found that applying a cube of ice to the area above the left eye on the side of the migraine headache is similarly effective.