Given Baby P/Shipman whats more important, evidence based medicine or admission ?

[ipsiLoquitor]

Thanks for the constructive input.
A couple of points. In general, the system is that a consultant will see a NP (New Patient) often in OPs (Outpatients). They will typically see the patient for longer and take a very full and complete case history. In follow ups this is often not the case. It depends in part on the interpersonal relations, style of consultant and so on. In general, a consultant would expect to be told of anything that might be serious/unusual. If the doctor doesn't do this it is likely, even in paediatrics, that the child will be sent home. The idea of 'working in isolation' hasn't been properly thought through or worked through yet partly because of cost considerations although 'single handed' GP Practices are becoming a thing of the past. Whilst there will always be mistakes no competent manager can practice with that attitude because it discourages the fresh analysis/practice which might reduce mistakes. In industry Six Sigma is used. The levels achieved in industry are not achieved in the NHS. There are many kinds of mistake, we could construct a differential for them, each has its own sign and symptoms, together with an appropriate treatment. In some cases this is prophylactic psychodynamic/psychological examination, I believe. Reviews normally happen over timescales measured in days at best and sometimes take considerably longer - especially when required to be officially reported. Once Baby P attended a doctor predisposed no to examine the fate, sadly, was probably sealed. It is important for me to be clear that the doctor concerned did not cause the baby's death. Perhaps she could have prevented it but of course by then it was too late. My hope is that her mistake and experience will be sufficient to get people to radically re-evaluate whether enough is being done. I notice you mention that I can't be a practising clinician yet believe that you must know that psychodynamic/psychological support is often ongoing in the mental health field and some areas of child protection ? The idea that it has a significant role to play is not new. The only question really is whether the profession would be humble enough to examine itself thoroughly - the irony here being clear I think.

[Granny Midges]

How can any assessment at the admission stage determine if and when a given doctor is going to make a mistake ???? Your theory is assuming that these doctors who have made mistakes are somehow inherently more liable to make mistakes and that it is possible to pick this up as the admissions stage ?? And according to your theory by eliminating these people from being admitted you are going to churn out 'better doctors' ???
Have you worked a whole day and then been on-call through the night,perhaps grabbing a sandwhich for a meal with little or no sleep in 24 hrs ? I have and I can tell you that it's very easy to make mistakes. I am not defending the doctor who made the misdiagnosis in baby p's case, what I am trying you tell you and failing miserably is that no pre- assessment at the admissions stage can pick out who is going to make mistake and who is not. Medical schools are there to train 'raw' material by giving them the knowledge and skills to diagnose and treat and to make sure there is some level of competence that individual has achieved.
As you have not answered my question as to whether you are a practicing doctor, I would strongly suggest you go and work shadow a doctor on call. It will be an eye-opening and hopefully an enlightening experience for you.

[Granny Midges]

Giella:

I noticed when I was helping someone with a university entrance exam (GMAT) and 'malevolent' was one of the '600 new words' words that it means having or exerting a malignant influence.

To describe me like this is an extraordinary cognition/perception.

Do you fear psychological/psychodynamic evaluation ? Is there something in my posts which you fear so much as to insult ? Do you doubt your own intelligence/motives? Thrall me with your acumen.

By the way the last paragraph of the quote above sounds like something Hannibal Lecter would say to Clarice in his sinister voice
LOL !!

[ipsiLoquitor]

It seems that like many people who have passed through the typical doctor's medical training your psychological/psychiatric knowledge is limited. It is already a fact that in the case of e.g. personality disorders, future behaviour can be predicted at least in the cohort as a whole. All admissions processes have to use predictors of future competence/success or they are no more scientific or prejudice free than a meeting of racists. There are two aspects which I can help distinguish (although more distinctions exist). First, personality profiling can detect certain behaviours likely to cause harm to others. Second, the modern psychological/psychodynamic techniques can indeed determine the likelihood of someone making a mistake. In the world outside medicine, this is what leads managers to tell staff to 'go home' at times i.e. is common sense. I suspect that your belief that only a doctor who has been on call can think clearly about child protection issues is widespread so that would probably rule me out if I am a lawyer or judge then ? Tiredness is also a state - but your reference to it seems to be tantamount to 'if only you knew how hard we work and how tired we get, you wouldn't make us think like this...' As far as experience is concerned would it surprise you if I mentioned that a Consultant Paediatrician agrees with me ? What if I made it up and only a porter agreed as someone previously suggested. Seriously, you have to get beyond judging an idea by the person voicing it. Its so incredibly unscientific - what if a porter had said 'that child looks ill to me mam' to the doctor. Doubtless you would give him/her a knowing 'we know best' look ? OR would you give him respect and double check ?

[ipsiLoquitor]

Giella:

Now you got the reference to a film (an exact quote). What about the references to various GMC documents and others that have littered what I have been saying ?

Thank you for posting without insult...take time to notice your feelings - you might get to enjoy it.

[ipsiLoquitor]

Giella:

Now you got the reference to a film (an exact quote). What about the references to various GMC documents and others that have littered what I have been saying ?

Thank you for posting without insult...take time to notice your feelings - you might get to enjoy it.

Whoops, was that not you Giella ?

[Granny Midges]

''personality profiling can detect certain behaviours likely to cause harm to others''
Yes, like serial killers you mean ?
If it is so effective why on earth is it not in place already saving countless lives ??
I am familiar with the testing and profiling assessments the military make their recruits go through. These try and ascertain whether certain individuals are fit to join the services according to their criteria. But this doesn't stop mistakes being made.

[ipsiLoquitor]

I am flabbergasted by the lack of knowledge you have Ms Midges. Have you noticed any of the political debate about detaining people with personality disorders without their consent in view of their danger to the public - about how maybe this shouldn't be done because 'it isn't treatable'. At the moment people believe they (10 of them) aren't treatable but I've never met a person who claims that they are universally undetectable. I think that Maybe it is the reference to Shipman which is causing the skew in the thread.

I am sure that you must have heard of the difficulty of proving a negative. In hospitals and outpatient settings up and down the country psychologists/counsellors/psychiatrists/resource centres and others work with those facing mental health challenges. It is in the nature of the work that any successes are invisible. This is one of the well-known drawbacks of evidence based medicine: if the processes needed to gather evidence are damaging the evidence won't be available except comparatively with other societies/countries which are problematic for various reasons.
Is it time now to turn to the question of

Which methodologies, at what stage, at what cost and to what end ?

[Granny Midges]

How arrogant ! You are obviously someone who is very used to having his/her own way. I do not agree with what you are proposing so I do not wish to discuss how to implement such a ludicrous idea.
Have you even considered what I have said in my posts ????
If I were you I'd go back to your paediatric consultant friend because I don't think you are going to convince any of the thousands of doctors/would -be doctors on this forum.
I wish you well with your endeavours.
GM

[ipsiLoquitor]

You know, I have already covered the issue of the malpractice of labelling that doctors get into (Sane people in Insane Places above) so it is unfortunate that you should demonstrate lack of competence in this area.

If you pursue 'reflective practice' and re-read the posts in their totality I think that you may feel ashamed at the quality of your arguments. I hope you do because the OP is predicated on the preventable death of Baby P and deserved a sober debate rather than name calling and defence of ego. You know as well as I do what goes on in the Psychiatric rotation, don't you ? Shall I spell it out or give details of the one I attended ?