We northern provincials always get excited when we come up to London for the day: as well as gawping at the posh people and hoping to absorb some culture, I could even pop into the City to see how those bankers are enjoying my taxation.
The journey does present challenges, though. First and foremost, what on earth to wear (our northern wardrobes not being adapted for the sweltering London micro-climate). Then there’s the whole Underground experience. And lastly the trust’s decision to ban first class travel, even for managers. Great.
Not only do I have to get up in the middle of the night to get to the station with my three alternative outfits, but I have to go second class without a Virgin Trains vegetarian cooked breakfast to prepare myself for the inevitable hour going the wrong way round the Circle Line.
The official reason for my visit is to attend a course on Improving Patient Safety (because nobody’s ever thought of this before, obviously). I’m quite looking forward to it really, as the alternative is an all-day orthopaedic list.
Just to show how enthusiastic I am about the course, I’m going armed with a couple of cracking ideas of my own which should reduce our mortality rate by at least 6%. The first is not to allow patients into hospital in the first place as it’s just far too dangerous: a hypothesis which is amply supported by the harrowing ‘patient stories’ related during the course; the second, for those patients who absolutely insist on admission, is to ban trainee doctors from the wards. Even those who’ve managed to actually pass their finals are apparently a danger to the public.
I know this will come as a shock, but a significant increase in deaths during August has been identified, which coincides suspiciously with the changeover of new doctors. Of course for generations no doctor in their right mind would have dreamed of allowing any family member to be admitted until at least the end of September.
When I was a new house-officer, we were all too knackered anyway after working a million hours a week to get too worked up about a couple of extra deaths every August. When a patient took a turn for the worse, there was a well-developed system to follow: a junior (usually me) told the relatives that their loved one had “passed away”. The relatives, obligingly keeping a stiff upper lip, said something along the lines of “it’s just one of those things, doc”, before cups of tea were handed round and nothing more was heard. No Critical Incident forms were filled in, and no-one from the trust risk management unit appeared to take statements.
We just carried on, no doubt making the same mistakes.
If it’s any consolation to our new trainees, I’m pretty sure that this year’s increased mortality pales into insignificance beside previous Augusts, especially the year I started when the changeover day was a Saturday so there was nobody in the hospital who could to site a venflon for two whole days. Fortunately the Standardised Hospital Mortality Ratio hadn’t been invented, so nobody took any notice.
I suppose some things really have changed for the better.
Tags: Juniors, Patient safety
