Patient safety

Day 275

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Recently, one of my friends, whose child happens to be autistic told me that she had managed to receive additional days of care for her son from her Local Council. It had been a bit of a fight as they normally would agree to much fewer days but she had put her foot down and was having none of their arguments. She had fought for the care her son needed.

It made me think about my role in the care of my son. While I repeatedly asked the GP to refer him to specialist services, and told him that I was really concerned about him again and again, I did not fight. I did not put my foot down and I did not demand that he must act on my request. Is it because I thought of him as a colleague and did not want to make his life difficult? Is it because I trusted his judgment implicitly? Or is it because I did not want to seem like a difficult parent? When I look back, I know that all along I had a feeling that all of us were missing something. I was uncomfortable. Instinctively I knew that not everything was being done to help him.

On looking back, it is easy to join up all the dots.

It is a pity we can’t do that as we go along.

Day 268

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Successfully completing medical school was an exhilarating experience but confusing at the same time. I figured that becoming a doctor was just the beginning. I had no idea where I wanted to go from there. What did I want to specialize in?

After a year and a half of trying this and that I found my vocation. It sounds cheesy to say that I did not choose Anaesthesia, it chose me. But that is true. It was just right for me. I learnt to comfort and reassure patients and their families just before their operations when they were vulnerable and worried. I developed delicate practical skills in the form of medical procedures and sensitive difficult conversations. I learnt a lot about patient safety as, when under anaesthesia, it is completely up to us to ensure that every patient is safe in every way possible. Maintaining good blood circulation and keeping the blood well oxygenated, hence keeping the patient alive is the very basic requirement.

In addition, we worry about the smallest things – a slight drop in temperature, a little scratch on the cornea of the eye or a tiny chip on a tooth, causing pressure sores or nerve injuries as a result of lying in one position for a long time or a bit of nausea or sore-throat after the operation. Many other seemingly tiny considerations are borne in mind to avoid the smallest possible complication.

Death directly related to anaesthesia is a highly unlikely event. A cause for much concern if it happens! Especially to a fit and healthy 20 year old lad.

Clearly, not all specialties think like we do. Every disease process is different and what is applicable in one field is not in another.

When it comes to safety there are many parallels drawn between medicine and the aviation industry. Martin Bromley is a pilot  who lost his young wife Elaine, when under anaesthesia. He has used that experience to educate a lot of people about the importance of Human Factors in medicine.

This video tells us his story and the lessons learnt. It is humbling to hear him speak. I have watched it many times and also used it for teaching junior medics. It is called “Just a Routine Operation”. A lot of learning in 14 minutes.