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

[ipsiLoquitor]

Is the earth still flat for you ?

[BeanOfJelly]

IpsiLocomoron:
Personally, I am flabbergasted by your lack of understanding and close-mindedness with regards to my banana test. Clearly your refusal to completely accept that my unsubstantiated/evidence-lacking proposal will magically predict which future doctors will make errors illustrates that you are not yet willing to open your eyes to the forces of change. Fortunately, being superior to you, I (and of course many others, given the strength of my argument) am not swayed by the popular belief in so-called evidence.
As Groucho Marx once said:
"I child of five would understand this. Send someone to fetch a child of five."
I belief this summarises my argument and brings our correspondence to an end. I bid you farewell, and hope that someday we shall meet so that you can at first be mystified by me, then befuddled by my curious occupation with beetles, before being awed by my humanity and sheer amazingness.

[Granny Midges]

LoL!!!!
BeanOfJelly-I love that word 'flabbergasted' !!
You are funny !
GM
x

[xXx H xXx]

As i read some of ipsi recent posts, i feel u hav pointed out sum valid arguments and reasoned them well, and do agree with the general idea that mistakes could be prevented and it is relevant to find methodologies to detect them. at the same time, i feel i am being warped into someones ideas that are based on solely the principles of psychology. u forget yet again that personality profiling has not provided evidence of being reliable in any stage, so u nver know, sinister serial killers such as shipman could have used their intelligence to work around these tests, if he had to do them now he could possibly blag his way through as a stable clinician.
as with the baby p case, u forget doctors are human, not robots, where an 'anomaly' could be detected in their personality and we could simply 'eliminate' them. even using psychodyanamic evaluation, mistakes that are bound to happen (at a later stage) cannot be predicted through analysis of a doctors 'mental state' at one stage, as ones mental awareness and self is continually changing, that is one of the beauties of a human 'being'. so carrying out weekly/monthly reviews in comparison to yearly reviews, would they really make a difference? in my opinion, no, time and money would be better spent on patients than doctors.
in this case, it is the system that failed, the doctor had perhaps to see to too many patients that she paid little attention to this cranky child. it has sadly cost a life, but you cannot say that is due to the doctors psychological 'defect', perhaps it was poor time-management and an excess of patients that caused her to carry out a quick diagnosis, hence a failure of the whole system.
therefore, in terms on what would be more beneficial to the public, i feel money would be better spent constructing methodologies that will improve this system than carrying out regular psychological reviews on doctors, end of the day doctors are there to save lives and these reviews will only make it more stressful and difficult. it is vital to ease their stress by investing money into improving the environment they work in(i.e. the system) than add to it so they could perform to their best of their ability. i feel you have undermined the credibility of our doctors 'ere.

[xXx H xXx]

i wud usually insult this geezer on how ridiculous some of his points r bh im tryna 'construct a coherent argument' ere...haha

nw awaiting either i)insult to my intelligence ii) reference to previous post that haz nowt 2do with what ive said iii) a counterattack with points and evidence that haz...nowt to do with what i said iv)all of the above???
i challenge u to cum out wit sumfink better than that. lol xxx

[Doc Skin]

I agree that the "system" should be changed. I was reading an article posted on another thread about consultants retiring in their 50's due to being overworked and basically being too knackered to continue practicing. Would it not be better to invest the money in more staff? Then consultants would not have to work 12 hour shifts then be on call all night. Mistakes are made when people are really tired, how can someone be fully competent at their job without being in good health themselves? It would also mean less patient's per doctor to examine. Maybe Baby P's paediatrician did have a long list of patients to examine that night and she made the fatal error of not spending enough time examining him.

Also IT is becoming more prominent in the NHS with the plan to keep patient's records electronically. Once this is implemented a plan could be secured to alert health care workers of vulnerable children and adults. So for example in Baby P's case, the first doctor to record bruising could put an alert on his file. Then any doctors doing subsequent check ups would see the alert and could also make their own alert on the file. If the paediatrician at the hospital accessed his medical history electronically instead of consulting his mother, she would have been immediately alerted to a sinister history of multiple suspicious injuries. Then I am sure she would have made that full examination.

These are only a couple of suggestions and I am sure there are many more ways to improve the system so avoidable mistakes like this are not made in the future.

[Doc Skin]

Should we not be trying to support doctors throughout their stressful careers rather than constantly assessing them and trying to catch them out at any opportunity? Doctors are already vulnerable to complaints and public scrutiny. Maybe the added stress of constant psychological/psychodynamic evaluations would dissuade many people going into medicine. This may weed out some of the incompetent ones, but also may mean the most suitable candidates are lost. Some of the incompetent ones would probably still end up practicing anyway because they will somehow slip through the net.

If we are going to implement change then why not make changes that will not only improve patient care but also help doctors perform better in their roles.

[ipsiLoquitor]

Thanks for the constructive input; few points.
Consultants leave the NHS for many reasons including to work in the private sector. The reality of ‘stress’ varies widely between different specialities and pensions are usually secured. (Pension costs, by the way, are often ignored when discriminating against older women [and men]).
Economics in general are often ignored. If we consider the normal rules of supply and demand it would be expected that in a ‘market’ which has excess supply (most people say that out of the approximately 1 in 7 who get a place, around 5 from 7 [or more] would make excellent doctors) price (wages) would come down or barriers to entry (a wider range of testing/criterion) increased. This doesn’t appear to be happening – because doctors are a ‘special interest group’. There is another elephant in the room here – more doctors doing less hours would mean lower wages for the doctors currently or in the future working. This is why it hasn’t happened. Otherwise, normal ‘economies of scale’ would apply.
The IT point is well made and in fact already practiced in some health settings in relation to many different issues. Provided staff are IT literate and confidentiality is maintained this would be an excellent ‘innovation’ in Paediatric settings. I like very much your orientation to ‘how we could do better’.
Most doctors would experience the quarterly evaluations as positive and even as improving confidence. Only a minority would be found to have the sort of ‘contaminated ego state’ which, once identified could be treated easily. If other conditions were found the doctor would legally be entitled to be supported through whatever treatment was required.
On a psychodynamic note, I had a message from someone who was surprised that I ‘treated’ a three year old thread...joining the dots...guess the point was missed.

[addy1]

Would it not be better to invest the money in more staff? Then consultants would not have to work 12 hour shifts then be on call all night. Mistakes are made when people are really tired, how can someone be fully competent at their job without being in good health themselves?

If the paediatrician at the hospital accessed his medical history electronically instead of consulting his mother, she would have been immediately alerted to a sinister history of multiple suspicious injuries. Then I am sure she would have made that full examination.
.

You aren't a doctor are you?
The last thing we need is someone coming along and cutting our hours (and therefore experience) further. Less qualified but not-quite-so-tired consultants are NOT a good thing.

Secondly history taking is part of the process of medicine. In fact I normally have a pretty good idea of what I suspect wrong with the patient in most cases before I examine them or take bloods. It's absolutely vital. If someone came in with "chest pain" and I wasn't allowed to take to them, I'd have to screen them for ACS, pneumonia, PE, aortic dissection, pancreatitis, the list goes on. A few simple questions narrows it down enormously. When patients with severe dementia or other communication/memory problems come in and there is no colateral history available our job is so much harder.
Yes old notes play an important role, but if we ever get to the stage where we stop talking to the patient , we are in big trouble.

"instead of consulting his mother" is just ridiculous. Yes, electronic records in conjuction with consulting his mother, but not "instead of".

[Doc Skin]

ok I was only making suggestions, no I am not a doctor yet and I am sure all that will come with experience.

The suggestion of cutting consultants hours came from an article I read, older consultants wanted to reduce their hours but the NHS was not flexible, it was all or nothing.

"instead of consulting his mother" was not intended to mean not talking to her or patients in general, ok I phrased that wrong, I meant as a secure back up because obviously consulting Baby P mother would not have provided the truth. Communicating with patients is always going to be paramount, their current symptoms may not be found in their medical history and we also want to make them feel at ease, hiding behind a computer won't do that.