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

[Gizmo says -]

Gizmo... if thats true i'm very sorry.

Granny Midges Gizmo, that is very sad news. Are you ok ?

ah, maccas, i wish it werent true and all. i walked in to find one of me best maccas, jus lying there, no movin'....quite a shocker, since i'd been living wif 'im for some three monfs now.
fank you for your condolences though. these are mush appreciated.


i am sorri to interrupt this argument, chaps and chappesses.

[mariposa]

ipsiLoquitor I notice you ignored the advice I gave you.... good luck with your applications to medical school. you are going to need it.

[ipsiLoquitor]

ipsiLoquitor I notice you ignored the advice I gave you.... good luck with your applications to medical school. you are going to need it.

Thanks Mariposa. Couple of points though.

You didn't give advice, you modelled fear.

I received my offers a fair time before you.

Anybody who has actually worked in medicine knows that a 3rd year medical student typically can't even spot a watershed (no not a viewing
threshold on tv). So, with the greatest of respect, I suggest you work on your neuroanatomy because at the moment some signal intensity appears to be missing.

[mariposa]

What a pleasant individual you are.

[andy-P]

Where's the popcorn?! :O
ipsiLoquitor you really really need to relax...It's a forum for discussion, you don't have to insult people who want to join the debate.
Andrew

[Gizmo says -]

What a pleasant individual you are.

mmm... ya ya ...he does sounds suspiciously like Patrick Swayze .......from 'Donnie Darko', macca.

[terpineol]

Sorry to hear about that Giz.

As for the thread, the sad fact of the matter is that at the end of the day people will always slip through the net, but from a consequentalist point of view is the investment required to try and avoid such cases worthwhile when looked at on a cost benefit level.

If we look at the Harvard study of adverse events in New York, and the National Patient Safty Agency we see that a certain number of deaths in care from missing things etc are inevitable.

As sad as this may be I fail to see how it is avoidable. Talking to people who went through the system years ago, the silly number of hours worked as a junior meant one saw everything, most importantly the rarer occasions when things don't go as one would expect them to, in terms of adverse reactions etc. Now supposedly this did lead to more accidental deaths, anecdotally at least, but it was felt that later on the greater experience reduced such accidents later in ones career, making it worthwhile.

The NPSA concluded for 2005-6 that
165000 harmed
4600 severe harm
2159 died

(copying from lecture slides here as i can't find the figures online, though i'm sure they are up there somewhere)

Now baby P and Shipman's bag are really a drop in the ocean if we look at these figures. But at the end of the day, we are all bound to end up making mistakes, as highlighted to me at least by a seminar we had from the psychiatric guys on the counseling services available post qualification. The line given by the chap in question that 'surgeons are especially commonly up as they know when they have killed someone, the vast majority of these deaths however being down to complications resulting from something that perhaps could have been done slightly differently.

At the end of the day, the point I'm trying to make is that there will always be misses, and personally I fail to see how screening for personality traits could be cost effective when if we view it as a means to avoid deaths such as those caused by Shipman, and more debatably Baby P, they represent such a small number of the bigger picture.



[there is some shocking grammar there, i'll pop back and try and neaten it up after a cup of tea, i've got brain rot.]

[Airtones]

In my experience a lot of the issues arrise from different patient expectations of the outcome. Patients almost unanimously misunderstand the role of the doctor to be a preserver of life. And while that is generally true, it is not exclusively always the case.

For example, consider an 85 yr old patient living alone with colorectal cancer. It is identified by the doctor and he is persusaded to go to hospital where he basically becomes resident for several weeks. His family are expecting the medics to restore his to his previous condition so he may return back to his life. The medics know that is not only unlikely, but not even an option on the table. Instead the plan is to pump him full of morphine so that at least when he does die in 3 weeks time it will be a clean and easy death in hospital with other people rather than alone at home in a puddle of his own filth.

[ipsiLoquitor]

Sorry to hear about that Giz.

As for the thread, the sad fact of the matter is that at the end of the day people will always slip through the net, but from a consequentalist point of view is the investment required to try and avoid such cases worthwhile when looked at on a cost benefit level.
]

From an accounting and economic perspective the 'worthiness is often miscalculated by even hospital accountants. The reason for this is the simple difference between micro and macro economic analyses.

At the level of the individual hospital, subscribed to the poled insurance system, it may certainly not always be worthwhile to actively pursue excellence in terms of avoiding preventable death and injury. (Of course, academic institutions currently take no responsibility for the doctors they train.)

However, for the economy as a whole there is little doubt that it is indeed worthwhile. The 'opportunity costs' of failing to prevent failure run into scores of different items and include: policing, enquiry, CJ, protection/supervision of offenders etc etc.

If one carries out the calculations in relation to this the cost of one 'failure' to the economy typically runs into 6 figure sums. If psychological assessment of would be doctors and medics could be improved to a level which prevented one death at a cost of around 3M it would indeed be worthwhile, not least for the patient but also for the economy as a whole.

This is one of the reasons why such measures have to come from the government in consultation with the appropriate professional/educational bodies.

Given that the current system could be improved as a first step (please note not my full proposal) by having compulsory psychological assessment for all those taking care of children, the mentally ill and so on through computer marked tests with follow-up 1-2-1 assessment only of those raising concerns (+ placebo for obvious reasons) this improvement is at once affordable, cost-effective and simple to implement - probably 'paying' for itself with the saving of just one 'avoidable' death such as Baby P's.

Note also that the costs outlined above do not cover 'unnecessary review and implementation of change' costs which may occur as an 'over compensation'.

[Eponine_hugo]

Thanks Mariposa. Couple of points though.

You didn't give advice, you modelled fear.

I received my offers a fair time before you.

Anybody who has actually worked in medicine knows that a 3rd year medical student typically can't even spot a watershed (no not a viewing
threshold on tv). So, with the greatest of respect, I suggest you work on your neuroanatomy because at the moment some signal intensity appears to be missing.

Hee hee hee, I vowed I wasn't even going to read this thread anymore, let alone post again but 2 things have drawn me to do so. Firstly bean of Jelly said he posted something so sarcastic he was proud and I had to check it out and secondly I am posting because the fear comment literally made me laugh out loud. Please guys, if you haven't watched Donnie Darko do go and watch it and think of the fear comments this guy comes out with. Ipsi you are so funny!