ADVERSE EVENTS ADVERSE EVENTS TO PATIENTS IN HOSPITALS TO PATIENTS IN HOSPITALS

FROM A PRIVATE PATHOLOGISTS FROM A PRIVATE PATHOLOGISTS PERSPECTIVEPERSPECTIVE

DR BRUCE DIETRICHDR BRUCE DIETRICHCEO, PATHCARE LABORATORIES,CEO, PATHCARE LABORATORIES,

CAPE TOWNCAPE TOWN

1.1. ADVERSE EVENTS IN HOSPITALSADVERSE EVENTS IN HOSPITALS

2.2. WHY SUCH EVENTS OCCUR?WHY SUCH EVENTS OCCUR?

3.3. WHAT CAN BE DONE ABOUT THEM?WHAT CAN BE DONE ABOUT THEM?

4.4. HOW DO YOU MEASURE & REPORT HOW DO YOU MEASURE & REPORT SUCH EVENTS?SUCH EVENTS?

5.5. HOW DO YOU MEASURE HOW DO YOU MEASURE IMPROVEMENT?IMPROVEMENT?

TEN MINUTES IS TOO SHORT A TIME TO BE ABLE TO TEN MINUTES IS TOO SHORT A TIME TO BE ABLE TO DISCUSS THE TOPIC FULLY.DISCUSS THE TOPIC FULLY.

1.1. MICROBIOLOGY SPECIMENMICROBIOLOGY SPECIMEN

ALL THREE OF THESE TOPICS ARE WELL DESCRIBED AND ALL THREE OF THESE TOPICS ARE WELL DESCRIBED AND DOCUMENTED INTERNATIONALLY.DOCUMENTED INTERNATIONALLY.

IN SOUTH AFRICA, IN THE PRIVATE SECTOR, THEY ARE IN SOUTH AFRICA, IN THE PRIVATE SECTOR, THEY ARE EXTREMELY IMPORTANT AND RELEVANTEXTREMELY IMPORTANT AND RELEVANT..

2. AUTOPSIES2. AUTOPSIES

3. DEFENSIVE MEDICINE3. DEFENSIVE MEDICINE

I HAVE CHOSEN THREE ASPECTS;I HAVE CHOSEN THREE ASPECTS;

ASPECT 1 - CLINICAL MICROBIOLOGYASPECT 1 ASPECT 1 -- CLINICAL MICROBIOLOGYCLINICAL MICROBIOLOGY

1. POORLY COLLECTED SPECIMENS1. POORLY COLLECTED SPECIMENS

ASEPTIC TECHNIQUESASEPTIC TECHNIQUES

ANATOMICAL SITES MOST LIKELY TO YIELD ANATOMICAL SITES MOST LIKELY TO YIELD ATHOGENIC ORGANISIMS E.G. SINUS TRACTATHOGENIC ORGANISIMS E.G. SINUS TRACT

CONTAMINATION BY INDIGENOUS FLORA CONTAMINATION BY INDIGENOUS FLORA IS MINIMIZED E.G. BLOOD CULTURESIS MINIMIZED E.G. BLOOD CULTURES

PERSON COLLECTING SPECIMENPERSON COLLECTING SPECIMEN

1. SITE OF SPECIMEN1. SITE OF SPECIMEN

2. ANTIBIOTICS PATIENT HAS 2. ANTIBIOTICS PATIENT HAS RECEIVEDRECEIVED

5. WHETHER THE PATIENT MAY BE 5. WHETHER THE PATIENT MAY BE INFECTED WITH PATHOGENS INFECTED WITH PATHOGENS KNOWN TO BE DANGEROUS TO KNOWN TO BE DANGEROUS TO LABORATORY STAFF.LABORATORY STAFF.

3. SPECIFIC PATHOGENS 3. SPECIFIC PATHOGENS SUSPECTEDSUSPECTED

4. METHODS BY WHICH THE 4. METHODS BY WHICH THE SPECIMEN WAS COLLECTEDSPECIMEN WAS COLLECTED

COMPLETE INFORMATION ON SPECIMEN COMPLETE INFORMATION ON SPECIMEN REQUEST FORMSREQUEST FORMS

SUCH INFORMATION IS NECESSARY SO THAT SUCH INFORMATION IS NECESSARY SO THAT SPECIMENS ARE;SPECIMENS ARE;

C. THAT THE LABORATORY PROCESSING ISC. THAT THE LABORATORY PROCESSING ISAPPROPRIATE FOR THE METHOD OFAPPROPRIATE FOR THE METHOD OFSPECIMEN COLLECTION.SPECIMEN COLLECTION.

A. PROCESSED PROMPTLY;A. PROCESSED PROMPTLY;

B. THE APPROPRIATE CULTURES AREB. THE APPROPRIATE CULTURES AREPERFORMED;PERFORMED;

SELECTING A REPRESENTATIVE SPECIMENSELECTING A REPRESENTATIVE SPECIMEN

1.1. APPEARS SIMPLEAPPEARS SIMPLE

THIS LEADS TO ERRONEOUS THIS LEADS TO ERRONEOUS DIAGNOSIS AND DIAGNOSIS AND

INAPPROPRIATE THERAPY.INAPPROPRIATE THERAPY.

2. MANY SPECIMENS ARRIVE 2. MANY SPECIMENS ARRIVE INAPPROPRIATELY SELECTED USUALLY ON INAPPROPRIATELY SELECTED USUALLY ON SWABSSWABS

EXAMPLES:EXAMPLES:1. WOUND SPECIMENS / SWABS1. WOUND SPECIMENS / SWABS

A. ANATOMICAL SITE MUST BE REPORTEDA. ANATOMICAL SITE MUST BE REPORTEDB. FROM THE ADVANCING MARGIN OF THE LESIONB. FROM THE ADVANCING MARGIN OF THE LESION

3. SPUTUM SPECIMEN3. SPUTUM SPECIMENA. MAY NOT BE THE SPECIMEN OF CHOICE FOR A. MAY NOT BE THE SPECIMEN OF CHOICE FOR

DIAGNOSING BACTERIAL PNEUMONIADIAGNOSING BACTERIAL PNEUMONIAI. BLOOD CULTUREI. BLOOD CULTUREII. BRONCHOALVEOLAR LAVAGEII. BRONCHOALVEOLAR LAVAGE

B. PROPER INSTURCTION PROVIDES A SUITABLEB. PROPER INSTURCTION PROVIDES A SUITABLESPECIMEN FROM LOWER RESPIRATORY TRACT SPECIMEN FROM LOWER RESPIRATORY TRACT

2. EAR SPECIMEN(E.G. OTITIS MEDIA)2. EAR SPECIMEN(E.G. OTITIS MEDIA)A. FLUID OBTAINED BY TYMPANOCENTESISA. FLUID OBTAINED BY TYMPANOCENTESIS

3. TRANSPORT OF SPECIMEN3. TRANSPORT OF SPECIMEN

1.1. STERILE SPECIMEN CONTAINERSSTERILE SPECIMEN CONTAINERS

3. PROMPTLY 3. PROMPTLY –– UNAVOIDABLE DELAYS UNAVOIDABLE DELAYS MUST BE MINIMIZEDMUST BE MINIMIZED

2. TRANSPORT MEDIA2. TRANSPORT MEDIA

4. STORAGE OF SPECIMEN4. STORAGE OF SPECIMEN

SPECIMENS REQUIRING PROLONGED STORAGE BEFORE SPECIMENS REQUIRING PROLONGED STORAGE BEFORE PROCESSING SHOULD BE REFRIGERATED.PROCESSING SHOULD BE REFRIGERATED.

CERTAIN SPECIMENS SHOULD NOT BE REFRIGERATED.CERTAIN SPECIMENS SHOULD NOT BE REFRIGERATED.

MATERIAL SUSPECTED OF CONTAINING NEISSERIA SPECIES MATERIAL SUSPECTED OF CONTAINING NEISSERIA SPECIES TRANSPORT RAPIDLY TO LABORATORY TRANSPORT RAPIDLY TO LABORATORY

BLOOD CULTURE BOTTLESBLOOD CULTURE BOTTLESLEAVE AT ROOM TEMPERATURE OR IN AN INCUBATOR LEAVE AT ROOM TEMPERATURE OR IN AN INCUBATOR

CSFCSFTRANSPORT AT ROOM TEMPERATURETRANSPORT AT ROOM TEMPERATURE

WRITTEN GUIDELINESWRITTEN GUIDELINES

THE GUIDELINES SHOULD BE COMPLETE, THE GUIDELINES SHOULD BE COMPLETE, EXPLICIT & UPEXPLICIT & UP--TOTO--DATE AND PREPARED BY DATE AND PREPARED BY LABORARORY STAFFLABORARORY STAFF

PROPER HANDLING OF CLINICAL SPECIMENS IS PROPER HANDLING OF CLINICAL SPECIMENS IS CRUCIAL FOR OBTAINING MICROBIOLOGICAL TESTCRUCIAL FOR OBTAINING MICROBIOLOGICAL TESTRESULTS THAT ARE BOTH TIMELY AND CLINICALLYRESULTS THAT ARE BOTH TIMELY AND CLINICALLYRELEVANT.RELEVANT.

WEINSTEIN & RELLERWEINSTEIN & RELLER

CLINICAL COLLEAGUES HAVE THE RIGHT TO ASSUME CLINICAL COLLEAGUES HAVE THE RIGHT TO ASSUME THAT MICROBIOLOGY RESULTS ARE ACCURATE,THAT MICROBIOLOGY RESULTS ARE ACCURATE,SIGNIFICANT AND RELEVANT. SIGNIFICANT AND RELEVANT.

REPORTING MISLEADING OR ACCURATE TESTS BUTREPORTING MISLEADING OR ACCURATE TESTS BUTINSIGNIFICANT INFORMATION, CAN BE AS HARMFUL ASINSIGNIFICANT INFORMATION, CAN BE AS HARMFUL ASREPORTING INCORRECT RESULTS. REPORTING INCORRECT RESULTS.

A LABORATORY REPORT IS ONLY AS GOOD AS THE A LABORATORY REPORT IS ONLY AS GOOD AS THE SPECIMEN COLLECTION. SPECIMEN COLLECTION.

THERE IS NO BENEFIT THERE IS NO BENEFIT -- AND THERE IS A AND THERE IS A POTENTIAL FOR HARM TO PATIENTS WHEN POTENTIAL FOR HARM TO PATIENTS WHEN SPECIMENS THAT HAVE BEEN IMPROPERLY SPECIMENS THAT HAVE BEEN IMPROPERLY COLLECTED OR IMPROPERLY TRANSPORED COLLECTED OR IMPROPERLY TRANSPORED –– ARE PROCESSED AND TEST RESULTS ARE ARE PROCESSED AND TEST RESULTS ARE REPORTED.REPORTED.

CORRECT LABELING IS OF PARTICULAR CORRECT LABELING IS OF PARTICULAR IMPORTANCE FOR ENSURING THAT PATIENT IMPORTANCE FOR ENSURING THAT PATIENT MISIDENTIFICATION DOES NOT OCCUR.MISIDENTIFICATION DOES NOT OCCUR.

ESCALATING ANTIBIOTIC RESISTANCE ESCALATING ANTIBIOTIC RESISTANCE

THERE ARE PATIENTS BEING TREATED, OFTEN THERE ARE PATIENTS BEING TREATED, OFTEN WITH COSTLY ANTIBIOTICS, WHEN IN FACT THEWITH COSTLY ANTIBIOTICS, WHEN IN FACT THEORGANISM ISOLATED HAS NOTHING TO DO WITHORGANISM ISOLATED HAS NOTHING TO DO WITHTHEIR CLINICAL STATE. THEIR CLINICAL STATE.

THIS KIND OF SCENARIO PROMOTES ANTIBIOTIC THIS KIND OF SCENARIO PROMOTES ANTIBIOTIC RESISTANT ORGANISMS.RESISTANT ORGANISMS.

LITIGATION HAS NOW ENTERED THE SPHERE OFLITIGATION HAS NOW ENTERED THE SPHERE OFMICROBIOLOGICAL DIAGNOSIS AND PATIENT MICROBIOLOGICAL DIAGNOSIS AND PATIENT TREATMENT. TREATMENT.

A POORLY COLLECTED SPECIMEN WITHOUT A POORLY COLLECTED SPECIMEN WITHOUT ADEQUATE CLINICAL INFORMATION, ALLOWINGADEQUATE CLINICAL INFORMATION, ALLOWINGFOR AN INACCURATE ANSWER & INAPPROPRIATE FOR AN INACCURATE ANSWER & INAPPROPRIATE TREATMENT WITH PATIENT DISSATISFACTION, IS TREATMENT WITH PATIENT DISSATISFACTION, IS NOW CAUSE FOR A LEGAL EXAMINATION & ACTION.NOW CAUSE FOR A LEGAL EXAMINATION & ACTION.

ASPECT 2 - AUTOPSIESASPECT 2 ASPECT 2 -- AUTOPSIESAUTOPSIES

THE DECLINING NUMBER OF AUTOPSIES BEING PERFORMED THE DECLINING NUMBER OF AUTOPSIES BEING PERFORMED ON PATIENTS DYING IN HOSPITALON PATIENTS DYING IN HOSPITAL

PATIENTS PARTICULARLY IN INTENSIVE CARE UNITS ARE PATIENTS PARTICULARLY IN INTENSIVE CARE UNITS ARE BEING INCORRECTLY DIAGNOSED.BEING INCORRECTLY DIAGNOSED.

DOCTORS FAIL TO NOTICE CONDITIONS SUCH AS HEART DOCTORS FAIL TO NOTICE CONDITIONS SUCH AS HEART ATTACKS, CANCER & PULMONARY EMBOLISM. ATTACKS, CANCER & PULMONARY EMBOLISM.

NOT NECESSARILY INCOMPETENCE NOR NEGLIGENCE ON THE NOT NECESSARILY INCOMPETENCE NOR NEGLIGENCE ON THE PART OF THE DOCTORS, BUT THAT SO FEW POST MORTEMS PART OF THE DOCTORS, BUT THAT SO FEW POST MORTEMS ARE NOW PERFORMED THAT DOCTORS DO NOT HAVE THE ARE NOW PERFORMED THAT DOCTORS DO NOT HAVE THE OPPORTUNITY TO LEARN FROM THEIR MISTAKES. OPPORTUNITY TO LEARN FROM THEIR MISTAKES.

TOO MUCH FAITH PLACED ON SOPHISTICATED TOO MUCH FAITH PLACED ON SOPHISTICATED INVESTIGATIONS IN MAKING DIAGNOSIS.INVESTIGATIONS IN MAKING DIAGNOSIS.

ASPECT 2 - AUTOPSIESASPECT 2 ASPECT 2 -- AUTOPSIESAUTOPSIES

FANG GAO SMITH, INTENSIVE CARE, FANG GAO SMITH, INTENSIVE CARE, BIRMINGHAM HEARTLANDS HOSPITALBIRMINGHAM HEARTLANDS HOSPITAL

1.1. IN 39% OF CASES OF DEATH IN THE IN 39% OF CASES OF DEATH IN THE INTENSIVE CARE. THEY FOUND MAJOR INTENSIVE CARE. THEY FOUND MAJOR PROBLEMS HAD BEEN MISSED.PROBLEMS HAD BEEN MISSED.

3.3. IF MORE HAD BEEN DONE MORE PEOPLEIF MORE HAD BEEN DONE MORE PEOPLEMAY HAVE BEEN SAVED.MAY HAVE BEEN SAVED.

2. FEWER AND FEWER AUTOPSIES BEING 2. FEWER AND FEWER AUTOPSIES BEING DONE IN THE UK, USA AND SOUTH AFRICA.DONE IN THE UK, USA AND SOUTH AFRICA.

JAMES UNDERWOOD, A PATHOLOGIST AT JAMES UNDERWOOD, A PATHOLOGIST AT THE UNIVERSITY OF SHEFFIELD AND THE UNIVERSITY OF SHEFFIELD AND PRESIDENT OF THE UKPRESIDENT OF THE UK’’S ROYAL COLLEGE S ROYAL COLLEGE OF PATHOLOGISTS,OF PATHOLOGISTS,

““WE SUSPECT THAT 30% OF DIAGNOSES WE SUSPECT THAT 30% OF DIAGNOSES MAY NOT BE CORRECT AT DEATHMAY NOT BE CORRECT AT DEATH””

FANG GAO SMITH STUDY COVERED THREE FANG GAO SMITH STUDY COVERED THREE YEARS,YEARS,

1.1. 2213 PATIENTS TREATED IN THE HEARTLAND 2213 PATIENTS TREATED IN THE HEARTLAND HOSPITAL INTENSIVE CARE. 636 DIED. HOSPITAL INTENSIVE CARE. 636 DIED.

5.5. IN 10 OF THESE CASES, PATIENTS MAY HAVE SURVIVED IF IN 10 OF THESE CASES, PATIENTS MAY HAVE SURVIVED IF THE DIAGNOSIS HAD BEEN ACCURATE (CRITICAL CARE, THE DIAGNOSIS HAD BEEN ACCURATE (CRITICAL CARE, VOLUME 7, ISSUE6) VOLUME 7, ISSUE6) –– 26%26%

2.2. JUST 49 POST MORTEMS WERE DONE & THE RESULTS JUST 49 POST MORTEMS WERE DONE & THE RESULTS OF 38 WERE AVAILABLE.OF 38 WERE AVAILABLE.

3.3. ONLY 17 OF 38 CASES HAD BEEN CORRECTLY DIAGNOSED.ONLY 17 OF 38 CASES HAD BEEN CORRECTLY DIAGNOSED.4.4. IN 15 MAJOR CONDITIONS HAD BEEN MISSED, INCLUDING IN 15 MAJOR CONDITIONS HAD BEEN MISSED, INCLUDING

3 UNDIAGNOSED HEART ATTACKS.3 UNDIAGNOSED HEART ATTACKS.

6.6. OTHERS SUFFERED UNNECESSARILY BECAUSE OF OTHERS SUFFERED UNNECESSARILY BECAUSE OF INAPPROPRIATE TREATMENT.INAPPROPRIATE TREATMENT.

SINCE 1991 THE PROPORTIONS OF DEATH IN SINCE 1991 THE PROPORTIONS OF DEATH IN THE UK HOSPITALS, FOLLOWED BY POST THE UK HOSPITALS, FOLLOWED BY POST MORTEMS HAS FALLEN FROM 1 IN 10 TO 1 IN MORTEMS HAS FALLEN FROM 1 IN 10 TO 1 IN 40.40.

DECLINE ACCELERATE IN PAST FEW YEARS DECLINE ACCELERATE IN PAST FEW YEARS FOLLOWING UPON THE SCANDAL OVER FOLLOWING UPON THE SCANDAL OVER BODY PARTS BEING RETAINED WITHOUT BODY PARTS BEING RETAINED WITHOUT THE FAMILYTHE FAMILY’’S PERMISSION. S PERMISSION.

THE SAME DECLINE IS EVIDENT IN THE USA THE SAME DECLINE IS EVIDENT IN THE USA AND SOUTH AFRICA.AND SOUTH AFRICA.

POST MORTEMS ARE UNPOPULAR BECAUSE;POST MORTEMS ARE UNPOPULAR BECAUSE;

1.1. RELATIVES DO NOT LIKE THEMRELATIVES DO NOT LIKE THEM

3.3. SHORTAGE OF PATHOLOGISTSSHORTAGE OF PATHOLOGISTS

2. THEY ARE EXPENSIVE / WHO PAYS?2. THEY ARE EXPENSIVE / WHO PAYS?

(R6000.00 or $1000.00 AND TIME OF CONSULTATIONS (R6000.00 or $1000.00 AND TIME OF CONSULTATIONS AFTERWARDS)AFTERWARDS)

MORTALITY MEETINGSMORTALITY MEETINGS

TIME OF PHYSICIANTIME OF PHYSICIAN

ADVERSE PUBLICITYADVERSE PUBLICITY

4. PHYSICIANS DO NOT WANT THE RESULTS TO SHOW 4. PHYSICIANS DO NOT WANT THE RESULTS TO SHOW THAT DIAGNOSIS WERE MISSED.THAT DIAGNOSIS WERE MISSED.

ASPECT 3 - DEFENSIVE MEDICINEASPECT 3 ASPECT 3 -- DEFENSIVE MEDICINEDEFENSIVE MEDICINE

MY LAST CONCERN IS THAT OF MY LAST CONCERN IS THAT OF ““BAD BAD MEDICINEMEDICINE”” ALSO RELATED TO LITIGATION ALSO RELATED TO LITIGATION (NEW SCIENTISTS 23 OCTOBER 2004). (NEW SCIENTISTS 23 OCTOBER 2004).

MEDICAL TREATMENT BEING INFLUENCED MEDICAL TREATMENT BEING INFLUENCED BY LITIGATIONBY LITIGATION

DR HAWK, A SURGEON, AT THE SOUTH DR HAWK, A SURGEON, AT THE SOUTH CAROLINA MEDICAL ASSOCIATIONCAROLINA MEDICAL ASSOCIATION’’S ANNUAL S ANNUAL MEETING, PROPOSED A MOTION THAT MEETING, PROPOSED A MOTION THAT DOCTORS SHOULD BE ABLE TO REFUSE TO DOCTORS SHOULD BE ABLE TO REFUSE TO TREAT LAWYERS AND THEIR SPOUSES! TREAT LAWYERS AND THEIR SPOUSES!

THIS PROVOKED OUTRAGE AMONGST THE THIS PROVOKED OUTRAGE AMONGST THE LEGAL FRATERNITY.LEGAL FRATERNITY.

THE MOTION WAS OBVIOUSLY DEFEATED.THE MOTION WAS OBVIOUSLY DEFEATED.

THE COST OF LITIGATION IN THE USA HAS ROCKETED THE COST OF LITIGATION IN THE USA HAS ROCKETED SINCE 1970SINCE 1970’’S.S.

1975 1975 -- $3 BILLION$3 BILLION20022002 -- $24 BILLION $24 BILLION

AS AWARDS GO UP, THE COST OF MEDICAL DEFENCE AS AWARDS GO UP, THE COST OF MEDICAL DEFENCE INSURANCE GOES UP THEREFORE MONEY HAS TO BE INSURANCE GOES UP THEREFORE MONEY HAS TO BE RECOVERED AND THE COST OF MEDICINE GOES UP.RECOVERED AND THE COST OF MEDICINE GOES UP.

THIS IS A HUGE DRAIN ON HEALTHCARE BUDGETTHIS IS A HUGE DRAIN ON HEALTHCARE BUDGET

WHILE THE PROBLEM IS MOST EXTENSIVE IN THE USA, WHILE THE PROBLEM IS MOST EXTENSIVE IN THE USA, OTHER COUNTRIES SUCH AS THE UK AND AUSTRALIA OTHER COUNTRIES SUCH AS THE UK AND AUSTRALIA ARE FOLLOWING THIS LEAD. THE SAME IS OCCURRING IN ARE FOLLOWING THIS LEAD. THE SAME IS OCCURRING IN SOUTH AFRICA. SOUTH AFRICA.

LITIGATION IS PROMPTING A SUBTLE AND INSIDIOUS LITIGATION IS PROMPTING A SUBTLE AND INSIDIOUS CHANGE IN THE WAY THAT MEDICINE IS PRACTICED, CHANGE IN THE WAY THAT MEDICINE IS PRACTICED, WHICH AFFECTS EVERYONE, EVEN IF THEY WOULD NOT WHICH AFFECTS EVERYONE, EVEN IF THEY WOULD NOT CONSIDER SETTING FOOT IN A LAWYERS OFFICE.CONSIDER SETTING FOOT IN A LAWYERS OFFICE.

IT IS KNOWN AS IT IS KNOWN AS ““DEFENSIVE MEDICINEDEFENSIVE MEDICINE””. .

DOCTORS ARE ORDERING TESTS, PRESCRIBING DRUGS OR DOCTORS ARE ORDERING TESTS, PRESCRIBING DRUGS OR EVEN CARRYING OUT SURGERY, NOT BECAUSE IT IS EVEN CARRYING OUT SURGERY, NOT BECAUSE IT IS NECESSARY, BUT TO AVOID BEING SUED IF THE PATIENT NECESSARY, BUT TO AVOID BEING SUED IF THE PATIENT FAILS TO MAKE A FULL RECOVERY. FAILS TO MAKE A FULL RECOVERY.

THE MORE MEDICAL INTERVENTIONS A PATIENT THE MORE MEDICAL INTERVENTIONS A PATIENT RECEIVES, THE BETTER A DOCTOR GENERALLY LOOKS IN RECEIVES, THE BETTER A DOCTOR GENERALLY LOOKS IN COURT. COURT.

1.1. UNWARRANTED XUNWARRANTED X--RAYSRAYS

2. OVER ORDERING OF LABORATORY 2. OVER ORDERING OF LABORATORY INVESTIGATIONSINVESTIGATIONS

3. POINTLESS ANTIBIOTICS3. POINTLESS ANTIBIOTICS

4. UNNECESSARY CAESAREAN 4. UNNECESSARY CAESAREAN SECTIONS. SECTIONS.

THE PARADOX IS THAT DEFENSIVE MEDICINE THE PARADOX IS THAT DEFENSIVE MEDICINE CAN BE WORSE FOR THE PATIENTSCAN BE WORSE FOR THE PATIENTS’’ HEALTH, HEALTH, NOT BETTER.NOT BETTER.

THE TREATMENTS AND INVESTIGATIONS THE TREATMENTS AND INVESTIGATIONS MAY BE DONE WITH THE AIM OF MAY BE DONE WITH THE AIM OF ELIMINATING THE SMALL RISK OF THE ELIMINATING THE SMALL RISK OF THE PATIENT SUFFERING HARM. PATIENT SUFFERING HARM.

HOWEVER THEY CAN EXPOSE THE PATIENT HOWEVER THEY CAN EXPOSE THE PATIENT TO SIGNIFICANT RISKS OF HARM, ALSO TO SIGNIFICANT RISKS OF HARM, ALSO EXTRA COSTS.EXTRA COSTS.

MANY OF THESE DAMAGE CLAIMS ARE MANY OF THESE DAMAGE CLAIMS ARE BASELESS. BASELESS.

NO MEDICAL PROCEDURE IS RISKNO MEDICAL PROCEDURE IS RISK--FREE AND FREE AND JUST BECAUSE A PATIENT SUFFERS HARM, IT JUST BECAUSE A PATIENT SUFFERS HARM, IT DOES NOT NECESSARILY MEAN SOMEONE DOES NOT NECESSARILY MEAN SOMEONE WAS AT FAULT.WAS AT FAULT.MEDICINE IS OFTEN A MATTER OF MEDICINE IS OFTEN A MATTER OF JUDGMENT AND GETTING IT WRONG MAY JUDGMENT AND GETTING IT WRONG MAY JUST BE BAD LUCK, NOT INCOMPETENCE OR JUST BE BAD LUCK, NOT INCOMPETENCE OR RECKLESSNESS. RECKLESSNESS.

JURIES HOWEVER, TEND NOT TO SEE IT THAT JURIES HOWEVER, TEND NOT TO SEE IT THAT WAY. WAY.

JURIES FACED WITH A PLAINTIFF WHO IS JURIES FACED WITH A PLAINTIFF WHO IS DISABLED OR CHRONICALLY SICK, HAVE A DISABLED OR CHRONICALLY SICK, HAVE A HISTORY (ESPECIALLY IN THE USA) OF HISTORY (ESPECIALLY IN THE USA) OF AWARDING LARGE PAYOUTS, OUT OF ALL AWARDING LARGE PAYOUTS, OUT OF ALL PROPORTION TO THE DOCTORPROPORTION TO THE DOCTOR’’S ERROR. S ERROR.

INCREASING SUMS BEING EXTRACTED BY INCREASING SUMS BEING EXTRACTED BY MEDICAL LITIGATION ARE LEADING TO MEDICAL LITIGATION ARE LEADING TO ROCKETING INSURANCE PREMIUMS FOR ROCKETING INSURANCE PREMIUMS FOR DOCTORS. DOCTORS.

SOME DOCTORS ARE NOW RELUCTANT TO SOME DOCTORS ARE NOW RELUCTANT TO WORK IN RISKY SPECIALTIES SUCH AS WORK IN RISKY SPECIALTIES SUCH AS OBSTETRICS AND GYNECOLOGY.OBSTETRICS AND GYNECOLOGY.

THE ENDTHE END