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Absolute hero. The NHS tried their hardest to be as negligent as possible with my wife. It's almost a copycat situation to be honest but she was lucky. Three da

by pling 12y ago

Absolute hero. The NHS tried their hardest to be as negligent as possible with my wife. It's almost a copycat situation to be honest but she was lucky. Three days on ICU and the surgery failed, plus she had an internal bleed where they did a "stupidly bad job" according to our current surgical reg. The surgeons were show-boating in this case. She's been through 4 years of shit getting a diagnosis to start with thanks to several GPs being disinterested or just incompetent, now a year of immobility after a fucked up surgery and now faces at least 2 years of recovery and rehabilitation. When it's over we're rolling out the legal eagles but based on past experience I expect to have to do a few weeks of forensics first and possibly get a court order to hand medical records over. Historically we've requested them and they've either been too expensive to prepare (ha) or completely disappeared. It's like chasing cockroaches with a torch. And this is a minor surgical issue (hernia).

jacquesm 12y ago
There are no such things as 'minor surgical issues'. Any surgery can lead to complications, no matter how minor the original ailment. Not knowing anything more than what you've outlined above various risk calculators give between 5 and 10% risk of (serious) complications. Depending on the particulars that could go down, or up much further but since you're seeing this as 'minor' even the low band of that range (around 5%) is sufficiently high to make you pause. Surgery is a risky thing, no matter how 'minor' you perceive it to be.
- pling 12y ago
  In this case all the issues were avoidable if they had followed procedure which they didn't. I have evidence of this. When I did the first poat surgery BP obs run (6 hours later - nurses had skipped her in post op, doctors not seen her either!!!) and found she was 70/40 @ 149bpm with 93% o2 saturation then I assure you its juat negligence. Plus they picked the wrong surgical method and placed the ports too close together so the laparoscopy had no chance of success. (I had another life before EE and software which was a little closer to the ground on this). I prefer to appear as ignorant as I can tell the difference between facts and fuzz.
  - jacquesm 12y ago
    I believe you. The problem is that surgery is complex and people are fallible. So things do tend to be forgotten and sometimes it's not a problem and in other cases it explodes into complications possibly even resulting in death. The statistics outlined above reflect this, it includes the element labeled as 'human error' (assuming they are up-front about this, which is in a litigious society not usually the case). A friend of mine almost had his wife bleed to death during delivery, she lost pretty much all her blood and was going out when they located a doctor capable of diagnosing the problem on the spot. He's a pretty tough guy and never at a loss for immediate solutions to whatever problems appear in life. He's never been so helpless. If not for one doctor out of a whole pile of people who happened to be there that seemed to be making things worse rather than better she'd have died. And that's 'routine childbirth' in the hospital (which they push you very much here to avoid, do it at home, so much more fun and natural)... Life is fragile, and as soon as you start cutting things or delivering babies or such then you're at risk. Routine tonsil surgery, hernias, gal bladders etc have left people with serious complications or in the morgue. I've had more than I would like to do with the insides of hospitals in the last couple of years and I try to avoid having procedures done unless they are absolutely necessary. I don't play the lottery either...
    - pling 12y ago
      The problem here is that we have a safeguard system which is a strictly defined set of processes and experience passed on from senior staff under the guise of "airway management", "infection control" etc. When these processes are not followed and no effort is made to even acknowledge their existence then it is no longer within the realms of human error. It is just negligence. This is the majority case when someone dies. They literally just left someone or skipped something or overlooked something they do every time successfully. We expect risk but we expect reasonable mitigation strategies rather than none. When this happens there is no excuse. None at all. Not a statistic, not a human error allocation, nothing. The same as if I can't be bothered to QA a change, roll it out and it screws up a client's financial data.
      - LindenRyuujin 12y ago
matthewmacleod 12y ago
Absolute hero. The NHS tried their hardest to be as negligent as possible with my wife. I'm sorry that your wife had poor care - nobody should have to go through that. But isn't the approach you've described exactly what we want to avoid in a healthcare system? Blame is almost poisonous in its ability to encourage people to cover up the truth, "misplace" documents, make excuses, and so on - this often actively hinders improvement. Applying the principles of air accident investigation to the NHS is absolutely something I applaud, because the focus should be on why accidents happen, and how they can be prevented — not on who is responsible for them, outside of the most egregious cases of professional failure. Most medical professionals are competent and skilled, and really try rather hard to avoid causing harm to their patients. But mistakes and accidents will always happen regardless of this. I'm actually very surprised that such a system isn't already in place in the UK. We've already got an independent body which investigates rail accidents, for example - the RAIB looks into all major irregularities or failures on the UK rail network, and rather than finding fault, identifies root causes for failures. That often includes things like the design of systems to reduce the possibility of human error, or even such things as shift patterns which risk causing sleep deprivation. They then issue recommendations for improvement to different bodies as required, and I think they have some legal clout to follow up if they're not implemented. It seems like a system similar to that would be effective applied to the NHS, but I'm very cautious of heading down the same litigious route as the US.
- paulhauggis 12y ago
  "Most medical professionals are competent and skilled, and really try rather hard to avoid causing harm to their patients. But mistakes and accidents will always happen regardless of this." I don't know if I believe this. I have found many medical professionals (not all of course) to be arrogant and cocky and even if you pointed directly to the cause of the problem, would most likely not think that those rules apply to them. "not on who is responsible for them" Mistakes happen because of people. If there isn't some sort of punishment or blame, the majority of people will just continue on with what they are doing (and the mistakes will continue to happen). We need to blame people, so they change their behavior and have less accidents in the future. We also need to know why it happened. "Blame is almost poisonous in its ability to encourage people to cover up the truth" If someone covers up the truth, they should be fired immediately. I honestly don't want someone like this working anywhere near the medical field..and neither should you. Children cover up their mistakes and lie..adults own up to their problems and admit when they made a mistake. Also, the reason pilots have less mistakes is because a computer pretty much does 99% of the work. This is not the case with surgery and medicine. Humans still do most of the work.

by pling 12y ago

jacquesm 12y ago

There are no such things as 'minor surgical issues'. Any surgery can lead to complications, no matter how minor the original ailment. Not knowing anything more than what you've outlined above various risk calculators give between 5 and 10% risk of (serious) complications. Depending on the particulars that could go down, or up much further but since you're seeing this as 'minor' even the low band of that range (around 5%) is sufficiently high to make you pause. Surgery is a risky thing, no matter how 'minor' you perceive it to be.

pling 12y ago
In this case all the issues were avoidable if they had followed procedure which they didn't. I have evidence of this. When I did the first poat surgery BP obs run (6 hours later - nurses had skipped her in post op, doctors not seen her either!!!) and found she was 70/40 @ 149bpm with 93% o2 saturation then I assure you its juat negligence. Plus they picked the wrong surgical method and placed the ports too close together so the laparoscopy had no chance of success. (I had another life before EE and software which was a little closer to the ground on this). I prefer to appear as ignorant as I can tell the difference between facts and fuzz.
- jacquesm 12y ago
  I believe you. The problem is that surgery is complex and people are fallible. So things do tend to be forgotten and sometimes it's not a problem and in other cases it explodes into complications possibly even resulting in death. The statistics outlined above reflect this, it includes the element labeled as 'human error' (assuming they are up-front about this, which is in a litigious society not usually the case). A friend of mine almost had his wife bleed to death during delivery, she lost pretty much all her blood and was going out when they located a doctor capable of diagnosing the problem on the spot. He's a pretty tough guy and never at a loss for immediate solutions to whatever problems appear in life. He's never been so helpless. If not for one doctor out of a whole pile of people who happened to be there that seemed to be making things worse rather than better she'd have died. And that's 'routine childbirth' in the hospital (which they push you very much here to avoid, do it at home, so much more fun and natural)... Life is fragile, and as soon as you start cutting things or delivering babies or such then you're at risk. Routine tonsil surgery, hernias, gal bladders etc have left people with serious complications or in the morgue. I've had more than I would like to do with the insides of hospitals in the last couple of years and I try to avoid having procedures done unless they are absolutely necessary. I don't play the lottery either...
  - pling 12y ago
    The problem here is that we have a safeguard system which is a strictly defined set of processes and experience passed on from senior staff under the guise of "airway management", "infection control" etc. When these processes are not followed and no effort is made to even acknowledge their existence then it is no longer within the realms of human error. It is just negligence. This is the majority case when someone dies. They literally just left someone or skipped something or overlooked something they do every time successfully. We expect risk but we expect reasonable mitigation strategies rather than none. When this happens there is no excuse. None at all. Not a statistic, not a human error allocation, nothing. The same as if I can't be bothered to QA a change, roll it out and it screws up a client's financial data.
    - LindenRyuujin 12y ago

matthewmacleod 12y ago

Absolute hero. The NHS tried their hardest to be as negligent as possible with my wife. I'm sorry that your wife had poor care - nobody should have to go through that. But isn't the approach you've described exactly what we want to avoid in a healthcare system? Blame is almost poisonous in its ability to encourage people to cover up the truth, "misplace" documents, make excuses, and so on - this often actively hinders improvement. Applying the principles of air accident investigation to the NHS is absolutely something I applaud, because the focus should be on why accidents happen, and how they can be prevented — not on who is responsible for them, outside of the most egregious cases of professional failure. Most medical professionals are competent and skilled, and really try rather hard to avoid causing harm to their patients. But mistakes and accidents will always happen regardless of this. I'm actually very surprised that such a system isn't already in place in the UK. We've already got an independent body which investigates rail accidents, for example - the RAIB looks into all major irregularities or failures on the UK rail network, and rather than finding fault, identifies root causes for failures. That often includes things like the design of systems to reduce the possibility of human error, or even such things as shift patterns which risk causing sleep deprivation. They then issue recommendations for improvement to different bodies as required, and I think they have some legal clout to follow up if they're not implemented. It seems like a system similar to that would be effective applied to the NHS, but I'm very cautious of heading down the same litigious route as the US.

paulhauggis 12y ago
"Most medical professionals are competent and skilled, and really try rather hard to avoid causing harm to their patients. But mistakes and accidents will always happen regardless of this." I don't know if I believe this. I have found many medical professionals (not all of course) to be arrogant and cocky and even if you pointed directly to the cause of the problem, would most likely not think that those rules apply to them. "not on who is responsible for them" Mistakes happen because of people. If there isn't some sort of punishment or blame, the majority of people will just continue on with what they are doing (and the mistakes will continue to happen). We need to blame people, so they change their behavior and have less accidents in the future. We also need to know why it happened. "Blame is almost poisonous in its ability to encourage people to cover up the truth" If someone covers up the truth, they should be fired immediately. I honestly don't want someone like this working anywhere near the medical field..and neither should you. Children cover up their mistakes and lie..adults own up to their problems and admit when they made a mistake. Also, the reason pilots have less mistakes is because a computer pretty much does 99% of the work. This is not the case with surgery and medicine. Humans still do most of the work.