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Content ArticleThis census of the consultant physician workforce in the UK conducted by the Royal College of Physicians shows that the number of doctors needed to meet patient demand continues to significantly outnumber the supply.
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Content ArticleThere are many respects in which the modern medical system is not fit for purpose and poses a threat to human health. In so many situations, our superficial assumptions about medicine are wrong. Having more tests to identify disease is often not better than leaving those “well enough” alone, labelling people with a specific disease may not be helpful, and more medicine may not be better than less medicine or no medicine at all. In our eagerness to intervene, we can end up doing harm. This fits with the estimation that around 30% of medical care is ineffective and another 10% is harmful. But why do doctors recommend tests, or diagnose and prescribe treatments that don’t help people? Ian A Harris, an orthopaedic surgeon, and Rachelle Buchbinder, a professor of clinical epidemiology, discuss in this BMJ opinion article.
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Content ArticleThis guidance from the General Medical Council sets out the how doctors should raise and act on concerns about patient care, dignity and safety.
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News ArticlePoliticians and doctors in Germany have called for urgent action to control the spread of COVID-19 after a record number of cases were reported on 11 November. Germany had 50 196 new confirmed Covid cases on 11 November, up from 39 676 cases on 10 November and 9658 on 1 November, showed figures from the Robert Koch Institute. A total of 235 Covid related deaths were reported on 11 November, up from 23 on 1 November. Speaking in the Bundestag, Germany’s lower house of parliament, the federal vice chancellor, Olaf Scholz, said that immediate steps must be taken to “winterproof” Germany against what is being described as the nation’s fourth wave of Covid-19. Scholz will meet next week with the prime ministers of Germany’s 16 states to discuss new measures to fight the pandemic. “The virus is still with us and threatens the health of citizens,” Scholz said, adding that efforts must be intensified to convince unvaccinated Germans to become fully vaccinated and encourage those already vaccinated to have the booster shot." Everything must be done, he said, to ensure “that millions of citizens get a booster—that is the task of the next weeks and months.” Read full story Source: BMJ, 12 November 2021
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Content ArticleThis best practice guideline for healthcare professionals covers optimum injection technique for people with diabetes taking injectable medications. It is an update to the original Injection Technique Matters guideline published in 2009.
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Content ArticleThis research gives insights into the views of doctors who were previously practising in the UK but who are not currently doing so, in terms of their characteristics, motivations and likelihood to return to clinical practice in the UK. A survey of over 13,000 doctors was carried out between 21 January 2020 and 10 March 2020. This report was developed in partnership between the General Medical Council (GMC), Health Education England (HEE), The Department of Health (Northern Ireland), NHS Education for Scotland (NES) and Health Education and Improvement Wales (HEIW).
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Content ArticleWhen Joe Fassler's wife was struck by mysterious, debilitating symptoms, their trip to the ER revealed the sexism inherent in emergency treatment.
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Content ArticleResearch shows that patient safety walk rounds are an appropriate and common method to improve safety culture. This observational study in The Joint Commission Journal on Quality and Patient Safety combined walk rounds with observations of specific aspects of patient safety and measured the safety and teamwork climate. Healthcare workers were observed in specific aspects of patient safety on walk rounds in eight settings in a Swiss hospital. They were also surveyed using safety and teamwork climate scales before the initial walk rounds and six to nine months later. The authors evaluated the implementation of planned improvement actions following the walk rounds. The authors found that walk rounds with structured in-person observations identified safe care practices and issues in patient safety. However, improvement action plans to address these issues were not fully implemented nine months later, and there were no significant changes in the safety and teamwork climate.
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Content ArticleQuotes from US doctors on the impact the pandemic has had on their hospitals and the care they are providing.
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News Article
Research confirms impact of COVID-19 on doctors’ mental health
Patient Safety Learning posted a news article in News
The COVID-19 crisis triggered high levels of anxiety and depression among doctors in the UK, Italy and Spain, a new study has found The research of 5,000 survey responses, across the three countries, found Italian doctors were most likely to have suffered during the crisis last year. The study, published in PLOS ONE, measured the mental wellbeing of doctors in Catalonia (Spain), Italy and the UK during June, November and December 2020. It found that around one in four medical doctors in Italy had experienced symptoms of anxiety in June and December 2020, with around one in five reporting symptoms of depression over the same period. In Catalonia around 16% of doctors reported anxiety and around 17% experienced depression. In the UK around 12% of doctors reported anxiety and around 14% had symptoms of depression. The study is among the first cross-country analysis of mental wellbeing among healthcare workers during the COVID-19 pandemic and the first to focus on medical doctors. Across all countries, female doctors and doctors under 60 were more likely to have anxiety or depression. Professor Quintana-Domeque, professor of economics at the University of Exeter Business School, who carried out the study said: “The COVID-19 pandemic has been classified as a traumatic event, with healthcare workers arguably having the most direct and longest exposure to this disease." “The results of this study suggest that institutional support for healthcare workers, and in particular doctors, is important in protecting and promoting their mental health in the current and in future pandemics.” Read full story Source: The Independent, 3 November 2021 -
Content ArticleHealthcare workers have had the longest and most direct exposure to COVID-19 and consequently may suffer from poor mental health. Quintana-Domeque et al. conducted one of the first repeated multi-country analysis of the mental wellbeing of medical doctors at two timepoints during the COVID-19 pandemic to understand the prevalence of anxiety and depression, as well as associated risk factors. Rates of anxiety and depression were highest in Italy (24.6% and 20.1%, June 2020), second highest in Catalonia (15.9% and 17.4%, June 2020), and lowest in the UK (11.7% and 13.7%, June 2020). Across all countries, higher risk of anxiety and depression symptoms were found among women, individuals below 60 years old, those feeling vulnerable/exposed at work, and those reporting normal/below-normal health.
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Content ArticleThis review in Medical Decision Making looks at how healthcare organisations might successfully use patient decision aids (PtDAs) to support person-centred care. It aimed to develop context-specific program theories that explain why and how PtDAs are successfully implemented in routine healthcare settings. Based on the results of their review, the authors recommend the following strategies for organisations wishing to embed PtDAs: Co-production of PtDA content and processes (or local adaptation) Training the entire team Preparing and prompting patients to engage, Ensuring senior-level buy-in Measuring to improve
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News Article
Trainee doctors 'scared to come to work'
Patient Safety Learning posted a news article in News
Some trainee doctors and consultants at one Welsh health board are "scared to come to work", a report has found. A report by the Royal College of Physicians (RCP) described "frightening experiences" staff faced at Aneurin Bevan University Health Board. Chronic understaffing and excessive workloads at the Grange hospital in Cwmbran were causing "very serious patient safety concerns", it added. The Health Board said it had taken the findings of the report very seriously. The report, obtained by BBC Wales, said that some trainee doctors and consultants were worried about working in case they lost their licence to practise. It also said the problems had caused some consultants to feel demoralised and on the brink of leaving. One trainee told the authors of the report: "On one overnight shift, I treated a four-year-old with seizures. The ambulance took six hours. Colleagues treated an 18-month-old with burns. Lots of kids come in with respiratory distress. Paediatric cases are not uncommon. We've treated stabbing victims. Colleagues delivered a baby earlier in the minor injuries unit. These things shouldn't happen at all." Another trainee said: "There's so much patient movement with [this] model. I recently sent someone from Nevill Hall to the Grange to get a scan, then to the [Royal] Gwent to get a follow-up procedure, then back to Nevill Hall. "That's three bed moves, three ambulance crews and three medical people dealing with the same patient. It's extremely inefficient." And another added: "I worry about the safety of the patients coming into this hospital." Read full story Source: BBC News, -
News ArticleWhite doctors applying for medical posts in London are six times more likely to be offered a job than black applicants, figures released under the Freedom of Information Act show. The new data also show that white doctors are four times more likely to be successful than Asian candidates or candidates from a mixed ethnic background. The figures were uncovered by Sheila Cunliffe, a senior human resources professional who works in workforce transformation across the NHS and the wider public sector. Cunliffe sent freedom of information requests to all 18 NHS acute trusts in London asking for a breakdown by ethnicity for 2020-21 of the numbers of applicants for medical jobs, shortlisted candidates, and candidates offered positions. Twelve of the 18 trusts shared their full unredacted data with The BMJ on all grades of job applications. Across these 12 trusts, 29% (4675 of 15 853) of white applicants were shortlisted in 2020-21, compared with 13% (2041 of 15 515) of black applicants, 14% (8406 of 59 211) of Asian applicants, and 15% (1620 of 10 860) of applicants of mixed ethnicity. Overall, 7% (1148) of white applicants were offered jobs, compared with 1% (188) of black applicants, 2% (1050) of Asian applicants, and 2% (188) of applicants of mixed ethnicity. Cunliffe said that the findings were just one indicator of the barriers that applicants from ethnic minorities faced. “The racism some of these results point to will be replicated in the day-to-day lived experience of staff working within the trust,” she said. “NHSEI [NHS England and NHS Improvement] need to look at data in a more detailed way and, where needed, set out to trusts their clear expectations and targets for improvement.” Read full story Source: BMJ, 13 October 2021
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News Article
HEE tells trusts to prioritise training, or services will suffer
Patient Safety Learning posted a news article in News
The quality and performance of services will suffer if medical training is not ‘prioritised and funded’ by trusts, Health Education England (HEE) has warned. HEE has set out actions in its “Covid training recovery interim report” that must be done alongside NHS England, the Department of Health and Social Care and others to protect post-covid workforce recovery. At the beginning of the pandemic, junior doctors’ training was severely disrupted because thousands of staff were redeployed to covid wards, while most routine elective operations and diagnostic procedures were stopped. HEE says training has still not returned to pre-covid levels, and fears there could be further disruptions over winter if significant volumes of elective care are cancelled. According to its report, if medical training is not “prioritised and funded”, the “long-term costs to service are significantly greater”. “If delivery recovery is prioritised over training recovery there will be an initial increase in service delivery time and value, but this will be followed swiftly by a reduction in service delivery time and value,” it warned. Read full story Source: HSJ, 13 October 2021 -
Content ArticleFollowing the major disruption to postgraduate medical education during the last year of the COVID-19 pandemic, Health Education England (HEE) has worked with NHS England & NHS Improvement, NHS Employers, the Department of Health and Social Care, the General Medical Council, the Academy of Medical Royal Colleges, and others to support training recovery as an urgent priority and mitigate the impact of the pandemic on doctors in training.
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Content ArticleThis article in The Primary Care Companion for CNS Disorders looks at the impact of the doctor-patient relationship on patient outcomes. It highlights issues that can arise in this relationship, looks at their causes and suggests potential solutions.
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Content ArticleThis article, published by the BMJ, discusses mandatory and voluntary medical error reporting programmes and comments that voluntary reporting by practitioners is usually more useful.
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News ArticleConsultants at a major tertiary centre have written to their chief executive, warning services are in ‘an extremely unsafe situation’ and calling for elective work to be diverted elsewhere. Surgeons and anaesthetists at the former Brighton and Sussex University Hospitals Trust — now part of University Hospitals Sussex Foundation Trust — said: “We are devastated to report that the care we aspire to is not being provided at UHS… we are forced to contemplate that it is not safe to be open as a trauma tertiary centre and we feel elective activity must be proactively diverted elsewhere.” The letter from BSUH’s anaesthetist and surgical consultant body is dated yesterday and was sent to UHSussex chief executive Dame Marianne Griffiths. The Royal Sussex County Hospital in Brighton — part of the trust — is the major trauma centre for the South East coast, from Chichester to parts of Kent. In the letter, seen by HSJ, the consultants claimed a shortage of theatre staff is leading to “clinical safety issues, gross operational inefficiencies and burnout within our remaining depleted staff groups”. Read full story (paywalled) Source: HSJ, 21 September 2021
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Content ArticleThe aim of this study was to determine the distribution of formal patient complaints across Australia's medical workforce and to identify characteristics of doctors at high risk of incurring recurrent complaints. It found that a small group of doctors accounts for half of all patient complaints lodged with Australian Commissions. It is feasible to predict which doctors are at high risk of incurring more complaints in the near future. Widespread use of this approach to identify high-risk doctors and target quality improvement efforts coupled with effective interventions, could help reduce adverse events and patient dissatisfaction in health systems.
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News Article
Shortfall of 50,000 doctors may overwhelm NHS in winter, BMA warns
Patient Safety Learning posted a news article in News
The NHS may be unable to cope this winter because of a “frightening” shortfall of more than 50,000 doctors, the head of the British Medical Association has warned. The number of medics in England has fallen further behind comparable European countries over the summer, ahead of what is predicted to be one of the worst winters in the 73-year history of the health service, Dr Chaand Nagpaul said. “Winter is an incredibly difficult time for the health service,” he said. “With flu season on the horizon and even fewer staff this time round, it’s a total unknown as to how well our services will cope – if they even cope at all.” With more GPs and hospital doctors quitting over the summer, the shortage has risen to 50,191, according to the BMA. This reflects a loss of 919 doctors in primary care and 110 in secondary care over the last two months. Yet more doctors are actively considering quitting in the coming months due to burnout and excessive workloads. “Alarm bells” should be ringing, Dr Nagpaul said. The workforce crisis means staff are working longer hours to keep up with patient demand. Some feel they have no choice but to hand in their notice to get the respite they need. This piles pressure on those that remain, Dr Nagpaul said. Last week, Prof Martin Marshall, the chair of the Royal College of General Practitioners, told the Guardian that GPs in England are “finding it increasingly hard to guarantee safe care” for millions of patients, because the shortage of medics means they are unable to cope with soaring demand." Read full story Source: The Guardian, 13 September 2021 -
Content ArticleAs part of a Patient Safety in Surgery Webinar Series held by Massachusetts General Hospital’s COMPASS (Center for Outcomes and Patient Safety in Surgery), Vivian Lee, president of Verily Health Platforms, shares strategies for leading quality improvement and change to work toward a healthcare system that provides better care, more efficiently and at a lower cost.
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News ArticleThe family of a senior medic and lifelong NHS campaigner have called for an investigation into his death as it took paramedics more than half an hour to arrive at his home after operators were told he was suffering a cardiac arrest. Professor Kailash Chand, a former British Medical Association deputy chair, had complained of chest pains before one of his neighbours, a consultant anaesthetist at Manchester Royal Infirmary, called 111 for help before telling the call handler within three minutes that he believed his friend was having a cardiac arrest. “I was answering their questions when Kailash’s eyes began rolling and he slipped into unconsciousness. That’s when I said ‘this looks like a cardiac arrest’ and to upgrade the call. They kept asking questions as I started CPR and asked for an urgent ambulance. That was two or two and a half minutes into the call." Evidence seen by i News shows that it took another 30 minutes after the neighbour told the operator about the cardiac arrest for the paramedics to arrive at Professor Chand’s flat in Didsbury, Greater Manchester. National standards for ambulance trusts show that ambulance trusts must respond to category 1 calls – those that are classified as life-threatening and needing immediate intervention and/or resuscitation, such as cardiac or respiratory arrest – in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes. Read full story Source: iNews, 3 September 2021
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News Article
Large-scale GP group says its doctors routinely have ‘unsafe’ workload
Patient-Safety-Learning posted a news article in News
The Modality Partnership, one of England's biggest general practice groups told HSJ that its GPs are regularly seeing more patients each day than is safe, after the number of people going to see their GP surged in the wake of Covid-19. Data has shown the provider’s GPs had an average of 20 patient contacts per day during April 2020, which has now risen to to an average of nearly 50 patient contacts per day. Modality, which had drawn up a report on the situation were quoted as saying, "There is just so much to cover – I am worried about missing something.” One partner at Modality who is also quoted in the report said: “An increasing number of patients I see are broken, often in tears, and seeking help to cope with the new stresses of life.” Read full story (paywalled). Source: HSJ, 31 August 2021 -
Content Article
How bad “cognitive ergonomics” can drain doctors’ brainpower
Patient-Safety-Learning posted an article in Culture
This article by Tanya Albert Henry discusses poor “cognitive ergonomics” and how the American Medical Association has studied burnout among doctors and is currently addressing issues causing and fuelling physician burnout—including time constraints, technology and regulations—to better understand and reduce the challenges physicians face.
