ARROGANT NHS DOCTORS FAILING TO LEARN

The fact that there is no effective penalty for mistakes in the NHS is background you need to understand fully the article below

Arrogance and complacency among doctors could lead to another medical disaster on the scale of the Bristol babies scandal, the Royal College of Surgeons has warned. Five years on, patients are dying on operating tables because some doctors are still failing to act on the lessons of the scandal that led to the deaths of 30 babies, the college says.

This weekend leading surgeons compared the operational failings causing surgical blunders in NHS theatres to the institutional deficiencies that contributed to Nasa's 1986 Challenger and 2003 Columbia space shuttle disasters. Tony Giddings, a member of the college's council and a former consultant surgeon, says the NHS has not changed its practices significantly since poor operating techniques led to the scandal at Bristol. "Do we need to have a second Bristol before we can actually make the cultural changes that are needed?" said Giddings. "We have continued to have avoidable deaths in surgery because the lessons that were so clearly set out in Sir Ian Kennedy's report [into the scandal] have not been acted upon."

Last weekend The Sunday Times disclosed that more than 300 babies a year were being left with brain damage because of oxygen starvation caused by lack of proper care at birth. A government watchdog also warned that more than 2,000 people died last year because of blunders by NHS staff.

Giddings says although most surgeons are now aware of their own limitations, some are still putting patients' lives at risk because they believe they are infallible. "There are some surgeons who have a seriously flawed opinion of their own capabilities," he said. "If you are a surgeon and doing dangerous work you need to have a degree of self-assurance and confidence but it can turn into arrogance. "Surgeons can become too familiar with the dangers of the operating theatre and lose that capacity to be properly respectful of those dangers. "After the first shuttle disaster, although the astronauts changed a few practices, their attitudes and beliefs did not really change and they still thought they were masters of their situation. Nasa had a second disaster and then they really had to change."

The college wants the government to make it mandatory for all surgeons to be trained in skills such as communication and teamwork. In 2001 Sir Ian Kennedy, the chairman of the Bristol inquiry, recommended national procedures whereby surgical teams - including the consultant, anaesthetist, and theatre nurses - should meet routinely to review their performance. This has not happened, according to the college, and, until it does, avoidable deaths will continue.

The college insists that the actual number of avoidable deaths are up to 10 times higher than the 2,159 patient deaths recorded by the National Patient Safety Agency, since only a fraction are reported. Research published in 2004 put the annual number of patient deaths due to medical error at 40,000.

In one notable case, Marc de Leval, a professor of paediatric surgery at Great Ormond Street Hospital for Children, admitted that mistakes he made in surgery resulted in babies' deaths. He volunteered to retrain in the early 1990s after seven babies he performed heart surgery on died. Another surgeon, a consultant urologist from southwest London, admitted this weekend that one of his patients died after he removed the wrong kidney. The patient later died of complications. The surgeon, who did not wish to be named, said it was essential that junior staff were free to speak up if they suspected a mistake. "There are surgeons who are fairly intimidating and people would feel it is difficult to challenge their views," he said.

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California’s latest drug deal hurts minority health

If you want to know why there are health disparities between different racial groups, the recent drug deal between the Democrats in the California legislature and Gov. Arnold Schwarzenegger is Exhibit A. The proposal to extort lower drug prices by removing or restricting new medicines that don’t meet a state-set price will only hurt those depending on the government for health care or prescription drugs. That’s par for the course for the state’s Medicaid patients, who are already subject to rationing of medicines, restrictive access to newer medicines, and delays in obtaining drugs that, while more expensive, can often be more cost effective, more convenient to use, and have fewer side effects. Not that the governor and his health director Kim Belshe are unaware of this negative impact on the health of the Golden State’s minority population. Several years ago, I was part of a group of health-care researchers that presented Belshe with data demonstrating that restricting access to new medicines based on price actually made people sicker and drove up total cost. One of my colleagues, Dr. Susan Horn, conducted a study showing that more regulations of the type now being proposed by the governor were correlated with an increase in patients’ use of more expensive medical services, treatment in emergency rooms and hospitals, and visits to doctors’ offices. Such government impositions not only place the poor at particular risk, but also increase the total cost of their medical care.

The use of drug therapy to treat mental illness—a large proportion of the state’s drug budget — provides a case in point regarding the dangers of limiting access to a variety of prescription drugs. Selective serotonin reuptake inhibitors (SSRIs) are used to treat depression and a variety of affect disorders. There are more than a dozen existing SSRIs. Yet, under California’s proposed price-control plan, Medicaid patients suffering from depression and related disorders are already limited to the cheapest drugs. If new ones came on the market that were demonstrably more effective, they would not be available unless they were discounted to a huge swath of the state’s population. The same would go for any type of new drug that came to market. As Loretta Jones of the Los Angeles-based Healthy African American Families notes, the gap between cutting-edge care and the needs of the poor would grow wider each year. Belshe knows better than to let this happen—and so does the governor who inveighed against price controls less than a year ago.

Indeed, because California is a $2 billion market and growing, its price-control regime would make it the last place in the nation to obtain access to new medicines. In Europe, the imposition of price controls and protracted price negotiations delays access to new medicines by up to 3 years. Studies have show—particularly in the treatment of cancer, Alzheimer’s, diabetes and heart disease—that the delay in the launch of new medicines translates into more death, higher health-care costs, and a lower quality of life. The Schwarzenegger-Democrat proposal would erect the same sort or rationing and it would harm Medicaid patients the most. Ironically, such a price-control regime—with its threat to cut 40 percent of the price of new medicines—undermines and wastes California’s investment in stem-cell research. For once the money is spent confirming basic science, which company will want to pursue development in a state that punishes profit?

The proposal actually rewards those who are uninsured but can afford to buy coverage, particularly those making $70,000 a year or more. (It also encourages health insurers to dump prescription-drug coverage. Why provide it when the state will force deep discounts down the throats of drug and biotech firms?)

For example, while the bill covers drug expenses that exceed 10 percent of income, it turns out that, according to the California Health Care Foundation, the average Californian spends more a year going to restaurants ($3,500) and entertainment ($2,800) than on out-of-pocket health expenses ($2,500). By that logic, the state should negotiate discounts at Spago’s and Disneyland, too. And since hospitals cost more than medicine, maybe the governor should start denying the poor access to surgery until hospitals provide a 40 percent discount to middle class people who don’t want to buy health insurance.

If the governor and the Democrats were serious about health care, they could promote low-cost insurance coverage instead of protecting the wasteful benefits package negotiated by the unions. Instead, they are promising to provide another middle-class entitlement by sticking it to the poor and deepening the health disparities between the races. This is about as disgusting as it gets in politics and in public health.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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