Friday, 13 February 2009

I believe the kids call it a "facepalm"

A facepalm, as pictured above, pretty accurately describes what I did when I heard the news last night.

Mary Harney, the Irish minister for health, has announced the formation of a committee to look at ways of reducing clinical mistakes in hospitals. This will be a panel of experts who will get together and publish a report in 18 months time, apparently.

Incidentally, there is also a "commission on patient safety" in existence in Ireland, whose role would appear to be the same as that given to this new committee. However, the commission recommended the setting up of this new panel back in July 2008. The minister announced it's formation yesterday. Indeed.

But this was what got me. Harney, in her distress at the interminable suffering over the practice of shoddy medicine by Irish hospital staff, admitted she had no figures for medical errors in Ireland. But she does know that "Medical claims were costing the state 60 million euro every year" and that the aim of the process was to "reduce adverse events in the health service, and to reduce litigation". So, eh.....seeing as you admit to not having any statistics for medical errors (despite setting up 2 expert panels to combat the "problem") how are you going to know if your new committee is having an effect, Ms Harney????

Now, Minister, I'm no economist. And I'm no risk analyst. But, and apologies for the bold capitals, I have a suggestion for you, if you want to reduce medical errors in hospitals..................


I'm glad I got that off my chest. I'll be here all week. I'm also available for Barmitzvas and public policy.

Dr. Thunder.


  1. You might like to listen to this...

    Fast forward 50 mins.,null,200,

    Harney would do well to listen to Sara Burke (Health Policy Analyst).

  2. Dr. Thunder,
    That was beautiful. Poetry.
    I think I love you.

  3. Well, in fairness Jane, you're only human :P

    Dr T

  4. Oh brilliant. Another committee, another report that nobody reads, another pile of paper on another shelf, another 18 months lost.

    And here, another facepalm.

  5. There has been an NCHD who was involved in a car accident very recently having been on the way to an interview post call. And I do not mean a small accident but a really serious one, and that persons survival is still a question at this time. Places like Navan/Drogheda has notorious having roads which has claimed the lives of many NCHD's post call. Who will explain to the parents of these NCHDs that their child died because of the DoH ignorance/ workforce planning attitude? And now they are planning to make us work for free and take away essential training grant? I think these lives lost should make the press, not for cheap publicity but expose the realities of an NCHD's life. What do the rest think?

  6. Oh my God, that's terrible, KroC.

    I've known several young NCHDs who committed suicide, and a few more who died suddenly, also post call or after doing a lot of call. Sleep deprivation is known to increase incidence of cardiac events. I've also known several who went off the road and one who ended up in the ICU of the hospital she had just come from working in.
    If you could send me some more info about the recent event I will post on this subject. You're right. It needs to get out there.

  7. Please under no circumstances publicise this unfortunate event. Do not dare use her as a martyr for you own ends. This was an unfortunate accident. Leave her family, friends and colleagues to continue their vigil.

    You demonstrate no respect by attempting to publicise this.

  8. Polomint, relax. I haven't "attempted" to publicise anything. I would never mention names or details of any story that would make anyone identifiable, and indeed if you look at any of my posts you will see I do not even use anecdotes about things that really happened in case someone would be able to identify a patient or colleague.

    The above commenter thought that people should hear about these stories, which is why I responded the way I did.
    I would not publicise anything anyone did not want publicised, and indeed have a rule about never mentioning names or details that may make anyone readily identifiable, be they patient or colleague.
    I will just stay away from this topic altogether, however I will continue to mention that we are at risk of RTAs when post call etc, when it is relevant. I suspect you misuderstood me when I said I post on this subject, all my posts are dealing with a subject, rather than mentioning specific names and events, and had I posted on this subject I would have simply spoken about the subject in question, rather than mentioning names etc, which I think anyone would agree is in very poor taste. I agree with the above poster, that people should be aware that this is an issue, if only to highlight to doctors that they are at risk when post call and hope that they don't drive or take extra care. However, I will say nothing.
    My sympathies to that family.

  9. As you are probably aware, the community of doctors in Ireland is small enough so that if you mention one incident the indivivdual invovlved can usually be recognised.

    On the subject of RTAs. If you are sufficiently incapacitated with tiredness then you should not drive!!. Simple as! Look at the regulations for truck drivers. In court/ insurance claim, even for a minor accident you wouldn't be able to defend yourelf. Trust me, it's happened. Secondly, more gardai, nurses etc die on the roads than doctors. It just happens.

    Regarding suicide in the profession, yes it is absolutely unfortunate, but 'call' cannot be used as an overwhelming mitigating event. It is depressing, yes, but come on, there has to be other events in the individual's life that play a huge role.
    Again, it just happens.

  10. The reason more gardai and more nurses die on the roads may be because there are a lot more of them!
    Just a thought.
    I would have to disagree that suicide "just happens" and that call cannot be significantly implicated. Chronic or recurrent sleep deprivation for extended periods of time has been definitively shown to cause neuropsychiatric disturbances as well as cardiac morbidity. Sleep deprivation is a form of torture as defined by the Geneva convention, and the techniques involved in using it as a form of psychological torture are almost identical to the way Irish doctors become sleep deprived. It makes for interesting reading.
    Essentially they keep the torture victim up until they are miserable from exhaustion, then allow them to fall asleep and then wake them by startling them after a few minutes, and do this as soon as they fall asleep again. For more than 30-40 hours.
    Kinda like an on call shift in a public hospital, anyone?
    When this is the only job you are trained for, and you feel you have to do it to make a living and get anywhere in your career, but you are so tired that another 10 years of it seems like more than you can handle in addition to all the other stuff people do to live, well, I've known a LOT of junior docs in Eire who say they've wished they were dead, or were so desperate for it to end or got extremely depressed etc. Not everyone feels they can leave everyone behind and go to Australia. Many feel trapped in a physically exhausting, stressful and emotionally draining job, maybe they have a mortgage, or kids, and can't afford to quit. Trapped.
    "It just happens" is no kind of attitude to have towards this at all. If it were patients, would we say "it just happens"? Or would we want to find out why so we could try and change things for the better, so maybe it would not happen so often.
    There is no shame in looking after yourself and your colleagues as well as your patients. If you and those you work with are happy healthy, secure and working within a supportive system that enhances their capabilities, then you and they will do your job well and give the best you can to patients and their families.
    If you hang on by a thread and try to just get through the day despite crap being thrown at you, then, well, you won't.

  11. A lot of people get into this job for the wrong reasons, parents, prestige, whatever. I don't agree with you saying that people feel they 'have' to work in this job or are trapped. If you can't do it, won't do it, if it's making you miserable then leave. You are a highly skilled individual. You can work in any job( although not in this climate). I've personally worked under some of the most arduous conditions in this country and I loved almost every minute of it when not shitting myself regarding multiple RTAs rolling in to ED.I learnt so much, did so much, I feel that nothing could phase me. Perhaps I wear it as a badge of honour, but I feel that if you can do that, you can withstand anything.
    I really disagree with your argument and perhaps you are one of the people who were pushed into medicine and I'm sorry if you were, but if you or anybody like you feel that way, then quit, work in some other aspect of medicine outside hospital. You are in a vocational profession and you are an adult with a choice. If you truely resent your job and all that it stands for, just quit. Simple as!

  12. I was referring to people in general-not me, polomint.
    I have no intention of ever quitting, and if I did, would not change my stance one iota. I chose medicine because I liked the subject and found it interesting. I always found it amusing that people considered a job where you had your hand up an ass every day was considered to be prestigious-but then, I have a weird sense of humour.
    I do not resent my job. I like my job. I resent that idiots with poor managerial and organisational skills make it unworkable in ONE of the countries I have worked. I resent that many in the healthcare fields are too passive, frightened, or just plain disaffected to try to effect change in a system that is clearly failing both staff and patients.

    Vocation? Please. Pull the other one. Calling medicine a vocation has for years been used to justify horrendous abuse of workers. Most people are not stupid enough to fall for it anymore.

    Medicine is a job. It is just a job. It is a highly responsible job that requires a high level of skill and expertise, and demands high standards and a commitment to upholding and improving those standards constantly.
    But it remains a job. Not a higher calling. Not a vocation. Those that feel they are answering " a noble calling" usually have ego issues of one sort or another and need to feel they are special or better than everyone else.

    Some people, polomint, need their job. Some people have mortgages, or children, or are supporting whole families on their income, as is often the case with many overseas doctors whose families cannot work here for a variety of reasons. Because you enjoy high stress and long working hours that are often dangerous, is that a justification for forcing others to accept these conditions or walk?
    No. It is not.
    You sound as though you may work in Accident and Emergency? correct me if this is not the case.
    Shift working, while it undoubtedly has its drawbacks, does not have the same effect as extended shifts with deliberate deprivation of sleep and meals.

    There is no reason, other than money, that working plans cannot be restructured to allow no shift longer than say, 15 hours. There are probably enough NCHDs now to do that. With proper organisation, training can be easily incorporated into these rosters.

    But it's better to sweep it all under the carpet. Those that won't accept being treated like crap for years on end are just doing medicine for the wrong reasons. Or they are weak in some way. The status quo is fine, and everything is ok.