Tom Goodfellow

System already exists for analysing death rates

Now I don’t normally consider myself a fashionista, (“you said it” mutters the daughter darkly) although I do believe that I cut a svelte figure among the old geezers at the gym.

However my attention was recently drawn to a cartoon in Private Eye depicting male models on the catwalk wearing designs by a genuine fashionista Rick Owens. One must expose oneself (sic) to new experiences and few clicks on google took me to the relevant sites although I warn you it is not for the faint hearted!

At the recent Paris fashion week his male models sashayed their way down the catwalk wearing what looked to me like ripped bin liners. However the stunning sensation was that beneath their garments they were all “going commando” and it was easy to tell because each had a discrete peephole or slash at groin level. Thus the audience was able to get quick tantalising glimpses of their genitals as they walked past.

I am no prude and, in the privacy of the clinical setting, we doctors get blasé about viewing male bits and pieces. And let’s be honest guys, unless you happen to have a physique like Michelangelo’s David, our dangly parts are not exactly our most attractive feature and are more akin to Mick Jagger’s wrinkly face!

In my opinion those guys on the catwalk just looked ridiculous and they would have been better advised to cover up!

But, oh dear me, this is precisely the opposite of the views expressed by the Secretary of State, Jeremy Hunt.

There is, it seems, a “cover up” scandal in the health service with one in a thousand patients “dying needlessly” due to medical errors and poor care.  If true (and it may well be) then this is indeed shocking. To address this he plans to introduce a new scheme of an annual review of two thousand deaths a year across the country which will, no doubt, result a league table and re-inforce the name-blame-shame culture in the “no blame” NHS.

We also learn that Labour plan to go one better by introducing a mandatory review of all deaths in hospitals in a sort of “my review is bigger than yours” way!

However I do have some news for the politicians (and much of the media). Such reviews do regularly take place in hospitals – they are called Morbidity and Mortality (M&M) meetings. These carry out (or at least should) exactly the functions that the SoS wants to introduce and, if properly run, they should review all deaths especially the unexpected, and also any unusual or serious complications. The findings of these meetings should then be fed back into the overall hospital governance system in order for trends to be identified and addressed. Significant cases should generate a serious case reviews which are examined in greater detail.

The problem is that the quality of M&M meetings may be very variable both between hospitals and individual departments and the reasons for this are obvious. They require a large amount of data collection and review, and this requires significant managerial and clinical co-ordination. The selection of cases may also be very unstructured depending on the openness of individual doctors.

Most clinicians are professional about this and want to identify and learn from mistakes and mishaps, although not all are willing to have their disasters aired in public.

But the most significant issue is that of time. In a busy department, in addition to preparation time, a properly run M&M meeting may take up to four hours and cannot be squeezed into a lunch break. So clinics, ward rounds and theatre sessions will need to be cancelled on a regular basis to accommodate this. Yet in these target-driven days it is not difficult to see why M&M meetings are not necessarily the first priority for managers and hospitals under pressure.

So, Mr Hunt, rather than introducing yet another stick with which to beat the medical profession why not invest in what is already up and running, but support and improve it. There should be national standards for the running of M&M meetings – these already exist for some specialities – and there is plenty of quality research out there. But you must also accept that there will be a cost – clinical time, and money to fund supporting staff.

Unlike Rick Owens’s male models most doctors are not too keen on being exposed for “trial by media” and increasingly these days “trial by GMC” if things go wrong. So Mr Hunt let’s have a bit less of the blame culture and try to be supportive instead. This is how you will gain the openness you seek – we all want the best for our patients – and well supported, properly functioning M&M meetings will go a long way in achieving this.

Over the next few months, leading up to the election, the politicians will be strutting their stuff on the catwalks, all determined to flaunt their assets to try to seduce us into voting for them. There will definitely be a few tools on display, but the PR teams will be working overtime to ensure we don’t see or hear anything too revealing!

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One Response to “System already exists for analysing death rates”

  1. Malcolm Morrison says:

    Well said, Tom!

    Why aren’t the models on the catwalk accused of ‘exposing themselves’ (flashing’)?

    And why aren’t the politicians accused of ‘misuse (wastage) of public money’ with their ‘new inniatives’ that will prove nothing? Maybe they, too could be accused of ‘exposing themselves’ – in that they are showing their ignorance rather than their private parts!

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