HIGH STAN­DARDS

Pi­lots, like doc­tors, make mis­takes, says Mau­rice Gueret, but the health sec­tor could learn a lot from air safety pro­ce­dures

Sunday Independent (Ireland) - Life - - HEALTH -

The lit­tle I know about medicine is a good deal more than my knowl­edge of fly­ing planes. But I have long won­dered, in inks and thoughts, why the health sec­tor doesn't learn more from those mag­nif­i­cent men and women in their fly­ing ma­chines. One such mag­nif­i­cent be­ing, a re­tired air cap­tain, shared his thoughts with me in a re­cent let­ter. He feels there are many pro­ce­dures and prac­tices evolved over the years that have greatly im­proved the safety of fly­ing, which could eas­ily be ap­plied to med­i­cal prac­tice, par­tic­u­larly those parts of it where a team is in­volved. In the old days of fly­ing, he says pi­lots were demi-gods who did as they pleased and could not be ques­tioned, leav­ing their crew en­tirely out of the loop. He tells me that pi­lots, like doc­tors, do make mis­takes and the pur­pose of new air­craft dis­ci­plines was to re­duce and rec­tify those caused by hu­man er­ror. The three dis­ci­plines he rec­om­mends are Check­lists (some­thing nurses know bet­ter than doc­tors), Stan­dard Op­er­at­ing Pro­ce­dures (ev­ery­one knows ex­actly what to do and when to do it, even com­plete strangers to each other) and Crew Re­source Man­age­ment (where ev­ery­one on board is in­volved and en­ti­tled to ques­tion and comment). Th­ese are cer­tainly wor­thy of con­sid­er­a­tion, and the only po­ten­tial span­ner in the works I can see is that pi­lots tend to serve one mas­ter and don't tend to work across two very dif­fer­ent sec­tors in the one day — pub­lic and pri­vate. Im­por­tantly, he says that mis­takes are not pun­ished, un­less there is gross neg­li­gence or pro­ce­dures have been wil­fully ig­nored. Re­me­dial train­ing is avail­able when nec­es­sary. All the med­i­cal er­ror fo­cus in Ire­land is on the short-term, set­tling claims as cheaply as pos­si­ble and keep­ing in­sur­ance pre­mi­ums to a min­i­mum. If preven­tion is truly bet­ter than cure, then the an­swer to a grow­ing cat­a­logue of med­i­cal er­ror may be pass­ing over our heads. The small pub­lish­ing house, Gib­son Square, has some in­ter­est­ing books out at the mo­ment. Spoilt Rot­ten: The Toxic Cult of Sen­ti­men­tal­ity, by re­tired prison doc­tor Theodore Dal­rym­ple, ex­am­ines mod­ern do-gooder trends in Bri­tain, where the real aim is to feel bet­ter about one­self rather than ef­fect­ing any real change for those less for­tu­nate. An­other, by Ea­monn But­ler, lends a larger hint to its con­tent in the ti­tle, The Rot­ten State of Bri­tain: How Gor­don Brown Lost a Decade and Cost a For­tune. But the book Gib­son Square has asked me to re­view is a work of fic­tion set in a celebrity men­tal health re­treat where treat­ments in­clude pa­parazzi ther­apy, gen­der-re­ver­sal bathing ses­sions and the sort of scream­ing ther­apy one used to as­so­ciate with re­mote is­lands off the Done­gal coast. Not my usual cup of tea, but the name of the author caught my eye. Re­hab Blues is the first novel of Adrian Laing, son of renowned Scot­tish psy­chi­a­trist RD Laing. Read­ers of a cer­tain vin­tage may re­call that the late Dr Laing was the man who was given such a frosty re­cep­tion on The Late Late Show in the mid-Eight­ies, you could be for­given for think­ing he had bed­ded a bishop. Happy to re­port that Re­hab Blues is a funny and chal­leng­ing read. It's witty, well ob­served and has a cast of sports stars, mu­si­cians and TV per­son­al­i­ties ex­hibit­ing all man­ner of bad habits and mod­ern de­range­ments. The Ox­ford Text­book of Psy­chi­a­try, it’s not. I think old man Laing might have ap­proved. A reader of the col­umn brings me back to 1945, when he was a boy of about six, liv­ing near Tem­ple Street Chil­dren's Hos­pi­tal in Dublin. He re­mem­bers be­ing taken by his mother to a base­ment room op­po­site Govern­ment Build­ings on Mer­rion Street, stood on a ta­ble and ex­am­ined, in his birth­day suit, by some med­i­cal staff. There was no pain or in­jury that pre­cip­i­tated the visit, but the out­come was a pro­longed stay in The Clon­tarf Or­thopaedic Hos­pi­tal, where he re­mem­bers a view of the pi­geon house. X-rays showed that the ball of his left hip had left the socket that was in­tended to house it and the treat­ment was a spe­cial bed that would stretch the leg and move the joint back into po­si­tion. He re­mem­bers a steel frame bed set at an an­gle, with a slid­ing sup­port on rails to sup­port his up­per body. His legs were taped in­side and out and at­tached to steel shoes with spring bal­ances mounted high on the bed end. He was bil­leted out­doors on the ground floor ve­randa but his bed was in the cor­ner so that by the time the urine bot­tle came around it was full. Af­ter about two years, he was dis­charged on two crutches. An ac­tive life fol­lowed of swim­ming, bad­minton and Dublin city marathons. As­sisted by this ex­cel­lent case his­tory, and a lit­tle ge­o­graph­i­cal re­search through old Med­i­cal Directory edi­tions, I sur­mise that my cor­re­spon­dent above was prob­a­bly treated by Mr Arthur Chance (1889-1980), who was the first ever pro­fes­sor of Or­thopaedic Surgery at Trin­ity Col­lege. Chance was a leg­endary teacher of bone con­di­tions across all med­i­cal schools and ac­cord­ing to Pro­fes­sor Barry O’Don­nell's bi­ogra­phies of Ir­ish sur­geons, was “a warm, chuck­ling, rounded fig­ure with a great love of life and surgery”. He was a well-recog­nised ex­pert wit­ness in the theatre of Dublin's courts, and his prop was a mon­o­cle which he pol­ished care­fully be­fore con­sult­ing his notes. The mon­o­cle could then be al­lowed drop from the eye with per­fect tim­ing if he felt the op­pos­ing ev­i­dence was in any way in­con­sis­tent. The Chance fam­ily, who lived in Nul­lam­ore (now home to Opus Dei in Dublin) played an im­por­tant role in the early life and ed­u­ca­tion of Dr Noel Browne. When Arthur Chance had a stroke late in life, it was Dr Browne who at­tended him and ar­ranged ad­mis­sion to hos­pi­tal. Full cir­cle. Dr Mau­rice Gueret is a GP and edi­tor of the ‘Ir­ish Med­i­cal Directory’ Email mgueret@imd.ie and Fol­low him on Twit­ter @mau­ricegueret

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