Tuesday, July 31, 2012

Why your risk of dying in hospital will rise...

Why your risk of dying in hospital will rise by 6 per cent tomorrow

By Lucy Elkins

Lisa Whelan knew within hours of her Caesarean that something was wrong.
As her baby girl lay contentedly snuffling in a cot beside her, Lisa started suffering from ‘agonising stomach cramps — just about as bad as labour pains’. 

As the 32-year-old mother from Leeds recalls: ‘By the next day, my stomach was not only painful, it was swollen.
'It looked as if I was about to give birth to twins.

Turmoil: Doctors didn't spot Lisa Whelan's Caesarean complications
Turmoil: Doctors didn't spot Lisa Whelan's Caesarean complications. 'I had to spend five months in hospital,' she said

‘I’d had a Caesarean with my first daughter 11 years ago — and I just knew this wasn’t normal.’ 

The junior doctor overseeing Lisa’s care thought it was trapped wind, and prescribed peppermint oil and suppositories.

Another junior doctor sent her for an X-ray but could see nothing wrong.
Three days after giving birth, Lisa started vomiting.

‘It was only then that a surgeon reviewed my notes and they realised something was seriously wrong,’ she says.
But by then it was too late: Lisa’s bowel had been perforated and had become septic.

She was rushed to theatre to remove the infected parts and was given only a 20 per cent chance of survival. 

In the end, despite multiple operations, it was not possible to save any of her bowel.
‘I had to spend five months in hospital and was sedated for so long I did not realise I’d had my baby until she was around two months old,’ says Lisa.

‘I finally got home in March, 2011.’

Not only that, but Lisa now has to face the future with a permanent colostomy bag.
What makes it so galling for her is that the hospital has since admitted that had she not been left in the care of junior doctors, this might have been avoided.

Junior doctor error led to an even more tragic outcome for Anita and Patrick Bowyer.
Their 26-year-old son Ben underwent an operation in March 2010 to relieve pressure due to a build-up of fluid on his brain, caused by a benign cyst. 

Doctors at the John Radcliffe Hospital in Oxford inserted a device to allow the fluid to drain off. 

‘We were told at the time that this was a holding operation and that they would remove the cyst a few days later,’ recalls Patrick, a self-employed plumber.
‘However, the consultant neurologist who had been in charge of Ben’s case then went off to London to teach for a week.

‘Ben was put on to a neurosurgical ward and left in the care of doctors in their first or second year out of medical school.’

On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards
On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards

Although Ben was ‘screaming and writhing in pain’, these junior doctors failed to realise how much his condition was deteriorating.

A week after his operation, and in the absence of the consultant, Ben died.
The inquest into his death heard that the drain was taking fluid from one but not both sides of the brain, causing fatal brain damage. 

The juniors did not recognise this, and while one did try to find a senior consultant to ask what he should do, this consultant later told the inquest he hadn’t been given the proper facts.

‘If he had, he said he would have authorised immediate  surgery,’ says Patrick.
The medical director of Oxford University NHS Hospital Trusts has since apologised to the family, saying: ‘The staff looking after Ben failed to recognise his deteriorating condition, which led to his death.’ The hospital has offered the family compensation.

A ‘junior doctor’ is a newly-qualified doctor who has spent five years at medical school and is now learning the ropes, working independently in a two-year foundation course in a hospital. 

It can be a sharp learning curve, with sometimes disastrous results.
On the first Wednesday of August every year, the latest tranche of junior doctors is launched on hospital wards. 

On that day the number of mortalities among patients brought into hospital increases by 6 per cent compared with the previous Wednesday, according to new research carried out by Dr Foster Intelligence.

‘I wouldn’t want a relative of mine to be admitted into hospital in August,’ one nurse who has been working in hospitals for the past 13 years told the Mail.

‘The junior doctors arrive fresh out of university and are expected to get on with it and you can see that many of them are really nervous and unsure what to do. 

'Most of them are keen for help and advice, but some arrive on the ward and you can tell that the fact that they have qualified as a doctor has gone to their head, and they think they know it all.’ 

Sir Bruce Keogh, medical director of the NHS, recently admitted that patients were at risk during this transition period, saying: ‘We recognise the change-over period in August puts patients at risk.

‘Junior doctors are under stress as they change from being a student to a professional, and they need help to adapt to a working environment when they’ve never done a job before.’

To try to put an end to the ‘killing season’, as this period has been dubbed, from next year junior doctors will have to shadow senior colleagues for four days before they start out. 

A pilot scheme in Bristol found this tiny change reduced the amount of mistakes made by junior doctors in their first four months at work by half.

The students benefited from familiarising themselves with the hospital, watching how seniors interacted with patients and nurses, and learning to locate life-saving equipment more quickly.
However, some believe there are other issues to addressed.
Indeed, it could be argued that it is a year-round problem. 

Another study carried out by Dr Foster Intelligence has found that in some hospitals the death rate at weekends rises by as much as 10 per cent — a time when, typically, senior staff are in short supply and it’s junior doctors who are in charge.

Lawyers involved with medical negligence cases have a high volume of complaints involving junior doctors.
‘Often they don’t seem to have the experience to see the severity of a situation,’ says Helen Hammond from Penningtons Solicitors.

‘In fairness, we also see quite a few cases where junior doctors are left to deal with a situation where they seek input from a more senior doctor but don’t get it.
'We also find that junior doctors are often left on their own during anti-social hours and help from a senior colleague is not that easy to find.’
This is a scenario Patrick Bowyer recognises.

‘At the inquest into Ben’s death, the two junior doctors involved were squirming and fearful,’ he says.
‘The point is, they did what they felt was right. The problem was there was no one of seniority around to guide them.’

In the past, too, medical students had more experience on the frontline with patients before they became junior doctors, says Dr Ben Dean, a registrar in orthopaedics based in Oxford, who himself qualified nine years ago. 

‘That changed when the General Medical Council took responsibility for a lot of a doctor’s training in about 2005;  it became more bureaucratic.
'Now there’s more formal  teaching, which is a good thing, but because of that there is less emphasis on clinical experience.’

It’s a problem junior doctors themselves recognise. 

When Dr Dean recently conducted a survey of 615 foundation doctors, a staggering 87 per cent believed that ‘incompetent trainees’ could still be allowed to pass the foundation stage because the testing was too focused on ticking boxes and less on core clinical experience. 

Another issue is the cut in hours. 

In 2009, a new European directive was introduced which capped the number of hours junior doctors can work to 48 a week.
‘Most junior doctors would be in favour of an increase in hours to around 50 or 60 per week, which would be better for doctors in terms of training continuity and better for patients in terms of continuity of care,’ says Dr Dean.

Junior doctors themselves recognise their limitations.
‘Part of being a doctor is recognising your limits and knowing when something is outside your competence and referring upward,’ says Dr Tom Dolphin, chair of the Junior Doctors Committee of the British Medical Association.

‘There have been some studies that suggest patients fare a little worse during the first few weeks of August, but that will also be contributed to by the fact that many other grades of doctor also rotate between hospitals on training programmes on the same day, and are therefore perhaps unfamiliar with the new hospital’s systems.

‘The problem is that training is not given much priority in a lot of hospitals and senior doctors are not being given time in their jobs to train their juniors.

‘Likewise, a lack of supervision overnight reflects understaffing and having too few doctors around to provide advice and support.

'Learning requires supervision.’ 

Currently, many patients may be cared for by junior doctors whose only supervision is by consultants at the end of the phone. 

As Carolyn Lowe of Henmans, the law firm that represented Ben Bowyer’s family, says: ‘We see far too many cases where junior doctors are left without adequate supervision and support.

‘They’re often put in charge of wards and expected to look after large numbers of patients — and, unsurprisingly, they struggle.
‘We welcome the shadowing scheme.

'However, one week just does not seem sufficient when patients’ lives are at risk.’






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