Performing clinical tasks without proper training?

The first postgraduate year of medical training (currently termed as the ‘F1 year’ in the UK) is an important year in which junior doctors make the transition from medical student to trainee professional. A recent paper in BMJ Open [BMJ Open 2013;3:e002723. doi:10.1136/bmjopen-2013-002723] looks at the views of over 14,000 doctors (in 6 graduation years) with regard to this critical year of training. The most interesting result relates to the fact that approximately one in six F1 year doctors felt they had been required to perform clinical tasks for which they felt inadequately trained. It’s difficult to pinpoint what’s behind these views. The authors themselves provide alternative explanations. For example, they wonder whether the European WTD have resulted in lost opportunities for education and training. The research is an important insight into this critical year, and I wonder to what degree the culture of the organisation contributes to this phenomenon. It’s worthy of more in-depth investigation. 

Patient perspectives ARE in important! So, the evidence says...

Exploring the perspective of patients in how healthcare is delivered is desirable on ethical, utilitarian and empathetic grounds. Encouraging patient ownership of their medical journey leads to improved patient safety, clinical effectiveness, better adherence to medication and treatment. A recent systematic review of the area (Doyle, Lennox & Bell, 2013: doi:10.1136/bmjopen-2012- 001570) provides evidence. It concludes that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. Indeed, the authors of the review state that;  “Clinicians should resist sidelining patient experience measures as too subjective or mood-orientated, divorced from the ‘real’ clinical work of measuring and delivering patient safety and clinical effectiveness”.

Strong words, physicians take note....

What doctors won't do

There was an interesting article in UK Guardian Newspaper on Saturday http://www.guardian.co.uk/lifeandstyle/2013/jan/19/what-doctors-wont-do?INTCMP=SRCH
It's not a scientific article, but a collection of comments form British healthcare professionals about what medical treatments they would avoid or not do. It's quite a revealing and should make us reflect on why patients are reluctant and don't "adhere" in the way that are supposed too. Interestingly, and appropriately, there are contradictions between the respondents. Our healthcare professionals as patients is a subject that we need to know more about.

Is experience important?

On the subject of prescriptions, the answer might be NO? BMJ OPEN has an interesting paper on prescription errors in UK hospitals [http://bmjopen.bmj.com/content/3/1/e002036.full.pdf+html]. Of 4238 prescriptions evaluated, one or more error was observed in 1857 (43.8%) prescriptions. Of these, 1264 (41.9%) were minor, 1629 (54.1%) were significant, 109 (3.6%) were serious and 9 (0.30%) were potentially life threatening. It shouldn’t be terribly surprising that such errors can happen, but what was surprising was the fact that grade was not a significant predictor of errors being made. The paper contains lots of information about the factors influencing errors (e.g., number of medications), but the question as to why prescriber experience does not seem to be important is not fully explored. It sounds like this could be a great PhD these for a cognitive psychologist. 

Do Doc’s falsify research results?

The BMJ has an excellent short article on the issue BMJ 2012;344:e2898 doi: 10.1136/bmj.e2898. The answer seems to be yes, but the degree to which data manipulation takes place is hotly disputed. Given the pressure on physicians to publish their work, I suppose it’s not so surprising that some medics have been observed cooking their data. It would be naive to think this problem is confined to medicine. However, it’s “reassuring” to see that physicians are as human as the rest of the scientific community. There will be a tendency to view it as an individual problem (i.e., a few rotten apples in the barrel), but it might be more interesting to ask what organisational elements combine to make research misconduct appealing?

Physicians and Euthanasia

A recent paper in the journal Bioethics [doi:10.1111/j.1467-8519.2012.01968.x] looks at differences between psychiatrists and physicians with regard to euthanasia. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. The authors of the research conclude that the study shows that psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. There is no doubt that this issue is an ethical minefield and one which is sure to exercise energy on both sides of the argument. It goes to very heart of what we consider to be reasonable suffering and pain.

UK doc’s rate hospitals poorly

A new survey from the Royal College of Physicians (RCP) found that over a quarter (28%) of consultant physicians surveyed rate their hospital’s ability to deliver continuity of care as poor or very poor. In addition, over a quarter (27%) believe that their hospital is poor or very poor at delivering stable medical teams for patient care and education.

See: http://www.rcplondon.ac.uk/press-releases/quarter-physicians-say-continuity-care-poor-their-hospital

The RCP website doesn’t provide much information regarding the survey, but its shame that we don’t know more about why physicians rate so their hospitals so badly. Is it the organisational culture or the psychological contract?  Are the reasons more related to  objective or subjective factors?