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

[Doc Skin]

btw the concept of checking patients records electronically was intended to mean the examining doctor would see alerts on the file if a child had frequent suspicious injuries, not that this would be used as the sole tool for obtaining his medical history.

[ipsiLoquitor]

btw the concept of checking patients records electronically was intended to mean the examining doctor would see alerts on the file if a child had frequent suspicious injuries, not that this would be used as the sole tool for obtaining his medical history.

Doc Skin makes some good points again. Please post further thoughts.

addy1 - you've come to the wrong forum. Here, the thread was posted to look at improved treatment of patients and specifically children - an attempt at a positive reaction to tragedy. Your point belongs more properly in a SIG (Special Interest Group not a type of gun) because of your perception of the needs of doctors many of whom do not agree with you. The key thing about experience in any case is not hours worked but experience gained and the two are not synonymous. Specifically, in the case of this thread which is about Baby P etc, experience occurred too late ! This is the point. Actions taken have to be ahead of time, proactive not reactive.

In psychodynamic work the comment 'the last thing we need' might be constructively interpreted to evoke a discussion of the feeling of being overwhelmed that doctors face at times. It would be very healthy indeed if healthcare professionals could distinguish between personal and systemic issues. The fact that it appears difficult to see beyond your own ambivalence towards long hours to the bigger picture of preventative medicine is intriguing for me. I'm uncertain that you might be 'facing both ways'. I'd like to hear more about your needs - but perhaps we could start a separate thread for this ?

[ipsiLoquitor]

If we don't strive to improve health care resourses, this may prove highly inefficient in terms of time and funds.

Quite right. Of course it is important to distinguish between microeconomic measures and macroeconomic measures. For example, in this thread which discusses the case of Baby P, the opportunity cost of protecting abusers needs to be considered. Quite often decisions may be made within a local health authority which do not make sense for the economy as a whole. This is a problem with devolved decision making. I have a wide range of proposals here but in this thread I just want to agree that there is an enormous cost implication of failing to assess doctors. Many economic costs are hidden and also 'public goods'.

[northoftherriver]

Ipsi, whats your point? That we should give personality tests to Doctors at interview to prevent them making mistakes at some point in the future?

What is the predictive power of these tests, and how does it compare to a more traditional interview? In particular, what is the evidence base for using psychodynamic approaches?

[Granny Midges]

...... and we'd like your answers in straight forward plain english please.

[addy1]

Doc Skin makes some good points again. Please post further thoughts.

addy1 - you've come to the wrong forum. Here, the thread was posted to look at improved treatment of patients and specifically children - an attempt at a positive reaction to tragedy. Your point belongs more properly in a SIG (Special Interest Group not a type of gun) because of your perception of the needs of doctors many of whom do not agree with you. The key thing about experience in any case is not hours worked but experience gained and the two are not synonymous. Specifically, in the case of this thread which is about Baby P etc, experience occurred too late ! This is the point. Actions taken have to be ahead of time, proactive not reactive.

What?
Find me a Doctor who doesn't think that History Taking is important! Find me a patient who doesn't think that the doctor listening to their story is important.

You will also be hard pushed to find a Doctor who thinks that our hours should be cut any further than they already are. And you will also struggle to find a Patient who wants a Consultant with such few hours under their belt that they are not as experienced as their colleagues.

It is not about "my perception of the needs of Doctors" at all, it's about patient care and how that is best delivered. You clearly have no concept of what constitutes good, patient centred care.
Yes, there are failings in the Baby P case, but cutting Doctor's hours and stopping them talking to relatives/patients are not the solutions.
Shipman was a clearly very disturbed man, whose motives we will probably never understand. Taking your suggestion to the extreme, why don't we do psychological testing on Teachers to check that they haven't got any underlying tendencies towards sexual abuse? Why don't we do psychological tesing on Bank workers to check whether or not they have a tendency to steal? In fact why don't we screen people after leaving secondary school and remove those with unwanted traits from society? I don't think so, do you?

Do you actually have any involvment in patient care at all? You seem to have very little in the way of understanding of the interactions between Doctors and their patients.

[Gizmo says -]

and we'd like questions in swahili, macca, and all.

[addy1]

In psychodynamic work the comment 'the last thing we need' might be constructively interpreted to evoke a discussion of the feeling of being overwhelmed that doctors face at times. It would be very healthy indeed if healthcare professionals could distinguish between personal and systemic issues. The fact that it appears difficult to see beyond your own ambivalence towards long hours to the bigger picture of preventative medicine is intriguing for me. I'm uncertain that you might be 'facing both ways'. I'd like to hear more about your needs - but perhaps we could start a separate thread for this ?

You are the most patronising person I have ever come across! It isn't a personal issue at all, it's an educational one. I would love to spend more time at home, having weekends off, never working nights etc. But that's not good for my development or my patient's care. I learn most of all when I am on-call. But I don't agree with shift work because I feel I learn (and therefore patients gain) from my being on the ward on a day to day basis, getting to know them and them having continuity of care.
What does the sentence "I'm uncertain that you might be facing both ways mean"? That isn't even proper English.

What do you actually do for a living? Are you a researcher? It seems you have some sort of bizzare notion that all Doctors are in it for themselves and don't give 2 sh*ts about their patients, which, for the most part is entirely false. The "system" frustrates us more than anyone, but cutting hours is NOT the way to go about it.

[Doc Skin]

so are you saying you are on the ward every day? Overworking yourself and burning out is not going to help you or your patients if you make a mistake because you are working yourself into the ground.

Maybe you will feel different when you are older and have a family? How can you possibly know now how you will feel when you are working long hours as a consultant in your 50's? I only said some want to cut their hours because that is what they actually said! It may suit you to work long hours but it does not suit everyone.

I believe it is important to spend as much time on the wards as possible at the start of your career in medicine because you have so much to learn. Although, once you are a consultant in your 50's you may still see new cases but you will not be learning at the same rate.

I agree that it is better for the patient to see the same doctors so they can have continuity of care, but I don't think many doctors would be committed to being on the wards 7 days a week.

[Doc Skin]

Yes, there are failings in the Baby P case, but cutting Doctor's hours and stopping them talking to relatives/patients are not the solutions.

Who said we should stop talking to relatives and patients? I know I mistakenly explained my concept by saying "instead of consulting his mother" but I later construed in another post:

btw the concept of checking patients records electronically was intended to mean the examining doctor would see alerts on the file if a child had frequent suspicious injuries, not that this would be used as the sole tool for obtaining his medical history.

Basically what I mean is in future cases we would not completely rely on the mother for the medical history, we would speak to her and also consult medical records to see if there is a questionable history.

Even if we did exclusively rely on electronic medical records, I do not see how this would mean we would stop talking to patients. How would we discover their current symptoms, feelings, needs or insecurities? How would we examine them, take bloods etc without explaining what we are doing and keeping them at ease.

I just think electronic records could be a useful backup for any case. When I am doing admissions sometimes even fully coherent patients forget to mention some pass medical history, I only find out when I check the A&E admission form and notice some additional conditions listed.