GMC gets tough with failing doctors

One of the many targets the government has imposed on the NHS is the “four hour rule” for Accident & Emergency Departments. All patients must be seen, assessed and dealt within four hours.

Dr Crippen has had a lot of fun looking at some of the strategies that three-star hospitals have adopted to circumvent the “four hour rule”.

“The second strategy is a joy. It was dreamed up by the high profile Chief Executive of a Three Star home-county hospital. He is called Andy Austin. (No, he isn’t)

The government does not want patients lying on trolleys (“gurneys” to you over there) in A&E for more than 4 hours.

So Austin has put a curtain across the middle of the A&E department and taken the wheels off the trolleys (gurneys) on one side. Suddenly, the trolleys are not trolleys, they are beds, and half the A&E department is not the A&E department, it is a ward. The staff call it Austin Ward.

Patients in Austin ward are no longer in A&E so can stay there as long as is necessary.”

(More of this delicious nonsense here)

Over in the colonies, a more robust approach has been taken. Not by the government but by the lawyers. Day by day, the USA becomes ever more litigious and the beleaguered medical profession is a coconut-shy for lean, hungry and unsympathetic lawyers:

In Waukegan, Ill., 49-year-old Beatrice Vance died of a heart attack after waiting two hours in a hospital waiting room. A coroner's jury has declared her death a homicide.

Reading the comments from doctors on the medical blogs was quite informative. The MD's basic attitude seems to be "shit happens and lawyers suck."
(Professor Bainbridge)

I think we can see where the learned professor is coming from. Personally, I do think that "shit happens" and I agree entirely (as do some of the commentators on the Professor's website) that, in this context, American lawyers suck.

So what happened to this poor lady?:

Vance was seen by a triage nurse at 10:28 p.m. According to hospital records, she complained of nausea, sweating and chest pain of a level she rated as a '10, with one being the lowest and 10 being the highest,' Barrett testified. 'The triage nurse classified her condition as 'semi-emergent,'' he said. (Chicago Tribune)

This was an error made by a "triage nurse". Yet another dumbing-down disaster. We all make mistakes, but it is hard to believe that a doctor would have missed this one. But, as always, you 'gets what you pays for'.

Triage is an inappropriate word in any case, a word borrowed from the battlefield.

Triage is a system used by medical or emergency personnel to ration limited medical resources when the number of injured needing care exceeds the resources available to perform care so as to treat the greatest number of patients possible. (Wikipedia)

Some would say that describes the NHS perfectly. It may end up like that. But at the moment, triage means that all patients coming into the ER in the USA or the Accident & Emergency department in the UK are assessed by someone who is not medically qualified.

Obviously, this tragedy in the USA will give rise to civil liability and rightly so. But homicide? Are the criminal law courts the correct forum in which to examine the case? The American lawyers may be rubbing their hands in glee but there is outrage amongst highly respected American doctors: see Gruntdoc & KevinMD.

A small collateral point en passant. What are the Americans doing to our language? What on God’s earth is a “semi-emergent condition"?

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And from the comments:

Another jolly wheeze at the A&E dept where I work is to suggest to the patient (if they are able) that they might like to pay a visit to the cafeteria or take a stroll round the grounds while they are waiting to be seen.

While they are out of the dept they are signed out and then signed back in again when they return. Hence a seven hour wait becomes two three and a half hour waits separated by a fifteen minute break, thereby not showing up as a "four-hour rule" breach.

Brilliant eh!

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Dr Crippen welcomes details of scams like this. Keep them coming!