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Content ArticleDisruptive behaviour can have a significant impact on care delivery, which can adversely affect patient safety and quality outcomes of care. Disruptive behaviour occurs across all disciplines but is of particular concern when it involves physicians and nurses who have primary responsibility for patient care. There is a higher frequency of disruptive behaviour in neurologists compared to most other nonsurgical specialties. Disruptive behaviour causes stress, anxiety, frustration, and anger, which can impede communication and collaboration, which can result in avoidable medical errors, adverse events, and other compromises in quality care. Healthcare organisations need to be aware of the significance of disruptive behaviours and develop appropriate policies, standards, and procedures to effectively deal with this serious issue and reinforce appropriate standards of behaviour. Having a better understanding of what contributes to, incites, or provokes disruptive behaviours will help organizations provide appropriate educational and training programs that can lessen the likelihood of occurrence and improve the overall effectiveness of communication among the health care team.
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Content ArticleThe depleting effect of repeated decision making is often referred to as decision fatigue. Understanding how decision fatigue affects medical decision making is important for achieving both efficiency and fairness in health care. In this study, Persson et al. investigate the potential role of decision fatigue in orthopaedic surgeons' decisions to operate, exploiting a natural experiment whereby patient allocation to time slots is plausibly randomised at the level of the patient. The results show that patients who met a surgeon toward the end of his or her work shift were 33 percentage points less likely to be scheduled for an operation compared with those who were seen first. In a logistic regression with doctor-fixed effects and standard errors clustered at the level of the doctor, the odds of operation were estimated to decrease by 10.5% for each additional patient appointment in the doctors' work shift. This pattern in surgeons' decision making is consistent with decision fatigue. Because long shifts are common in medicine, the effect of decision fatigue could be substantial and may have important implications for patient outcomes.
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Content ArticleDoctors are dying by suicide at higher rates than the general population—somewhere between 300 to 400 physicians a year in the US take their own lives. This article in The Guardian looks at why so many surgeons are dying to suicide and what can be done to stop the trend. It examines how the culture of working long hours and the expectation to be 'superhuman' leads surgeons to suppress their symptoms and avoid seeking help for mental health issues. The article also tells the story of US surgeon and President of the Association of Academic Surgery Carrie Cunningham, who has lived with depression, anxiety and a substance abuse disorder for many years.
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Content ArticleA recent report found that a third of female surgeons have been sexually harassed at work. In this opinion piece, Dr Liz O’Riordan speaks out about the abuse she suffered from male colleagues while working for the NHS. She describes her experiences, highlighting that incidents of sexual harassment are common amongst female surgical trainees who fear speaking out as it may affect their careers. She also draws attention to the fact that it is not just an issue amongst surgeons, but that many other healthcare professionals experience inappropriate sexual comments and behaviour while at work.
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News ArticleA police investigation into allegations of cover-up and medical negligence over dozens of deaths at the Royal Sussex county hospital (RSCH) in Brighton has been expanded to include more recent cases, amid internal claims about dangerous surgery. In June the Guardian revealed that Sussex police were investigating the deaths of about 40 patients in the general surgery and neurosurgery departments at the RSCH. The force initially said the investigation, since named Operation Bramber, related to allegations of medical negligence in these departments between 2015 and 2020. It has now extended the scope of the investigation to more recent cases, amid internal allegations that the departments continue to be unsafe and fail to properly review serious incidents. An insider said the police should review what was considered to be an avoidable death after a procedure in July. The source said some of the surgeons remained a danger to the public. “You would not want your family members touched by these people,” they said. They added: “This is not a historic issue, it is ongoing. The same surgeons that were involved in previous problems remain in place.” They cited a woman who lost the power of speech in April after an alleged mistake in surgery to remove a brain tumour led to a stroke, and a man who was left with a brain abscess in May after being operated on despite a heightened risk of infection. Read full story Source: The Guardian, 13 September 2023
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News Article
MPs to investigate sexual harassment of female surgeons
Patient Safety Learning posted a news article in News
MPs will investigate the sexual harassment and sexual assault of female surgeons taking place within the NHS. BBC News reported women being sexually assaulted even in the operating theatre, while surgery took place. And the first major report into the problem found female trainees being abused by senior male surgeons. The Health and Social Care Committee said it would look into the issue and its chair, Steve Brine, said the revelations were "shocking". "The NHS has a duty to ensure that hospitals are safe spaces for all staff to work in and to hold managers to account to ensure that action is taken against those responsible," Mr Brine said. "We expect to look into this when we consider leadership in the NHS in our future work." Read full story Source: BBC News, 13 September 2023 -
News Article
Female surgeons sexually assaulted while operating
Patient Safety Learning posted a news article in News
Female surgeons say they are being sexually harassed, assaulted and in some cases raped by colleagues, a major analysis of NHS staff has found. The Royal College of Surgeons said the findings were "truly shocking". Sexual harassment, sexual assault and rape have been referred to as surgery's open secret. There is an untold story of women being fondled inside their scrubs, of male surgeons wiping their brow on their breasts and men rubbing erections against female staff. Some have been offered career opportunities for sex. Nearly two-thirds of women surgeons that responded to the researchers said they had been the target of sexual harassment and a third had been sexually assaulted by colleagues in the past five years. Women say they fear reporting incidents will damage their careers and they lack confidence the NHS will take action. It is widely accepted there is a culture of silence around such behaviour. Surgical training relies on learning from senior colleagues in the operating theatre and women have told us it is risky to speak out about those who have power and influence over their future careers. Read full story Source: BBC News, 12 September 2023 Related reading on the hub: Breaking the silence: Addressing sexual misconduct in healthcare Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024 -
Content ArticleThis research examined sexual misconduct occurring in surgery in the UK, so that more informed and targeted actions can be taken to make healthcare safer for staff and patients. A survey assessed individuals’ experiences with being sexually harassed, sexually assaulted, and raped by work colleagues. Individuals were also asked whether they had seen this happen to others at work. Compared with men, women were much more likely to have seen sexual misconduct happening to others, and to have it happen to them. Individuals were also asked whether they thought healthcare-related organizations were handling issues of sexual misconduct adequately; most did not think they were. The General Medical Council (GMC) received the lowest evaluations. The results of this study have implications for all stakeholders, including patients. Sexual misconduct was commonly experienced by respondents, representing a serious issue for the profession. There is a widespread lack of faith in the UK organizations responsible for dealing with this issue. Those organizations have a duty to protect the workforce, and to protect patients. Further reading: Breaking the silence: Addressing sexual misconduct in healthcare Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign GMC's Good medical practice 2024
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News ArticleA hospital review of mesh operations by a surgeon who left dozens of patients in agony is now looking into another type of procedure he carried out. Tony Dixon, who used mesh surgery to treat bowel problems, has always maintained he did the operations in good faith. Now it has emerged that other patients who had their rectum stapled are also being written to. Spire Hospital Bristol said its "comprehensive" review remains ongoing. Mr Dixon pioneered the use of artificial mesh to lift prolapsed bowels and a review of the care he gave patients receiving Laparoscopic ventral mesh rectopexy has already concluded. Now the Spire has contacted patients who underwent a Stapled Transanal Rectal Resection (STARR operation) with Mr Dixon. Many of the affected patients have told the BBC they did not give informed consent for the procedure and are in chronic pain. Read full story Source: 11 September 2023
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News Article
Public inquiry to be held into disgraced brain surgeon
Patient Safety Learning posted a news article in News
A public inquiry will be held into the disgraced brain surgeon Sam Eljamel, the Scottish government has confirmed. Eljamel harmed dozens of patients at NHS Tayside, leaving some with life-changing injuries. He was head of neurosurgery at Ninewells Hospital in Dundee until December 2013, when he was suspended. Health Secretary Michael Matheson said he was persuaded of the need for the inquiry after reading a damning due diligence review into NHS Tayside. It follows a long-running campaign which saw almost 150 former patients of the surgeon calling for the inquiry. Mr Matheson said he had concluded that a public inquiry was "the only route to get to the bottom of who knew what and when, and what contributed to the failures described by NHS Tayside". The health secretary said he also wanted to see individual cases reviewed independently of NHS Tayside in a "person-centred, trauma-informed" manner. Read full story Source: BBC News, 7 September 2023 -
Content ArticleDemand for surgical and non-surgical cosmetic treatments has spiralled in the past ten years among men and women, especially young women in the 18-34 age group, thanks to social media, reality TV and celebrity endorsements. A corresponding increase in ‘botched’ procedures is putting pressure on the NHS to solve problems created by unregistered, unqualified practitioners. Official advice is to check your practitioner is qualified and has appropriate insurance. This makes sense but it’s not always easy to know where to look. That’s why the Professional Standards Authority have done the hard work for you. The Check a Practitioner service exists for situations like these. You can check if a practitioner is regulated by law or belongs to a reputable Accredited Register.
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News Article
Turkey surgery warning as mother-of-four dies after gastric sleeve
Patient Safety Learning posted a news article in News
A father whose daughter died after travelling to Turkey for weight-loss surgery has urged people to think again before doing the same. Shannon Meenan Browse from Londonderry was 32 when she died in August. The mother-of-four travelled for a gastric sleeve operation 18 months ago but, according to her father, got sick almost straight away. The family were told she died in Altnagelvin Hospital from "malnutrition due to gastric sleeve". A BBC investigation in March found that seven British patients who travelled to Turkey for weight-loss surgery died after operations there, while others returned home with serious health issues. One of the UK's leading bariatric surgeons, Prof David Kerrigan said people are taking a "massive risk" by travelling abroad for weight-loss surgery. In the UK, he said, patients undergo a rigorous preparatory process that includes a psychological assessment and there is "a proper after-care programme". Read full story Source: BBC News, 6 September 2023 -
Content Article
To mark this year’s World Patient Safety Day (WPSD), the Royal College of Surgeons of Edinburgh (RCSEd) will be running a series of blogs and Talking Heads on key surgical and dental topics in this area. These have been provided by patients, families and carers, alongside members of the College’s Patient Safety Group, College Council and the wider College fellowship. The College’s eleven Surgical Specialty Boards (SSBs) have been asked to provide blogs on how patient involvement in their individual specialty has helped to drive up standards of care. The blogs will provide examples of how patients and carers can play vital roles in making decisions about their own individual care and also how they can enhance the safety of the healthcare system as a whole by contributing to strategic decisions at organisational level. Two blogs will be released on each day of the College’s week-long WPSD campaign, starting on Monday 11 September and leading up to WPSD on Sunday 17 September. Members and Fellows will have access to these through the College website following the campaign. -
News Article
NHS failed to act on brain surgeon who harmed patients
Patient Safety Learning posted a news article in News
NHS Tayside has been criticised over its handling of disgraced brain surgeon Sam Eljamel in a new report. The internal due diligence review criticised health board management for putting the doctor under indirect supervision in June 2013 rather than suspending him. The surgeon harmed dozens of patients but was allowed to continue operating until he was suspended in late 2013. Some of his patients were left with life-changing injuries. He was employed as a surgeon by NHS Tayside for 18 years and later became the head of the neurosurgery department in Ninewells Hospital in Dundee. NHS Tayside has apologised to former patients of Prof Eljamel and committed to assisting in the Scottish government's independent commission for patient concerns. The health board claimed it became aware of concerns around the surgeon in June 2013, but an NHS whistleblower told the BBC the health board knew as early as 2009 that there were serious concerns. He is now working as a surgeon in Libya. Read full story Source: BBC News, 1 September 2023 -
Content ArticlePatients have better outcomes with female surgeons, a study from Wallis et al. has found. In a cohort study of 1 million patients, those treated by a female surgeon were less likely to experience death, hospital readmission, or major medical complication at 90 days or 1 year after surgery. This association was seen across nearly all subgroups defined by patient, surgeon, hospital, and procedure characteristics.
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News ArticleDetails of allegations against a surgeon who left dozens of patients in agony after undergoing mesh operations have been published. A tribunal will look at whether Tony Dixon failed to provide adequate clinical care to six patients at Southmead Hospital and the private Spire Hospital in Bristol. He had pioneered the use of artificial mesh to lift prolapsed bowels. The surgeon, who was dismissed in 2019, has always maintained the operations were done in good faith, and that any surgery could have complications. The Medical Practitioners Tribunal, which starts in Manchester on 11 September and is due to end on 23 November, will look into allegations that between 2010 and 2016 Mr Dixon failed to provide adequate clinical care in a number of areas, including: ensuring procedures for some of the patients were clinically indicated adequately advising some of the patients regarding options for treatment obtaining informed consent before performing clinical procedures adequately performing a procedure for one patient providing adequate post-operative care for some communicating appropriately with some of the patients and their family members. Read full story Source: BBC News, 24 August 2023
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News Article
Surgeon damaged dozens of patients by misplacing screws in their backs
Patient Safety Learning posted a news article in News
Every day Sharon Smith has to take a strong morphine tablet to dull the excruciating pain she has lived with for more than a decade. “I am in chronic pain every day. It’s affected our whole family and I’ve lost all my independence,” said Smith, from Leigh, Greater Manchester. Over four years from 2009, she endured three operations on her spine at Salford Royal Hospital, which as an NHS trust was once fêted as England’s safest. But the hospital had a dark secret: an incompetent leading surgeon who, an independent review would later find, had already “contributed” to the death of a girl in 2007. Now a wider investigation has confirmed that dozens of other patients who went under John Bradley Williamson’s knife were harmed or received poor care. Read full story (paywalled) Source: The Times, 30 July 2023- Posted
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Content ArticleIn 2021, a multi-professional staff support group was established under the Northern Care Alliance NHS Foundation Trust’s Freedom to Speak Up process which raised new questions and concerns around the probity and clinical standards of a Consultant Spinal Surgeon (“Consultant Spinal Surgeon A”) whilst they were employed at Salford Royal NHS Foundation Trust (now part of the Northern Care Alliance NHS Foundation Trust) (“the Trust”). As a result, the Trust commissioned the Spinal Patient Safety Look Back Review (“SPSLBR”) and Investigation Group to evaluate these concerns, including obtaining independent expert advice.In January 2022, the Trust commenced the SPSLBR to investigate and manage patient safety concerns raised in respect of Consultant Spinal Surgeon A who was employed at Salford Royal NHS Foundation Trust (now part of the Northern Care Alliance NHS Foundation Trust) between 1991 and January 2015. This report outlines the investigation carried out by the SPSLBR Investigation Group on behalf of the Trust to investigate and manage potential Serious Incidents (“SI”) caused by the errors and omissions attributable to clinics, surgery and/or consultations undertaken by Consultant Spinal Surgeon A within the scope identified in the Terms of Reference.
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News Article
Health officials took months to investigate surgeon Sam Eljamel
Patient Safety Learning posted a news article in News
Health officials waited six months to speak to the surgeon Sam Eljamel after a complaint was made about his conduct that eventually led to his suspension. Eljamel, who was head of neurosurgery at NHS Tayside in Dundee between 1995 and 2013, harmed dozens of patients before being suspended in 2013. Even as NHS Tayside commissioned an external review into Eljamel’s conduct, the surgeon was not suspended. Instead, the health board allowed him to continue practising as long as he was monitored. However, a letter sent to Eljamel by NHS Tayside’s clinical director, dated June 21, 2013, reveals that the surgeon was able to negotiate the extent of his own supervision. It was during this period of supervision that Jules Rose attended Ninewells Hospital to have a brain tumour removed by the surgeon. He performed two surgeries on her, in August and December, and she later discovered that he had removed her tear gland instead of the tumour. Since then she has founded and run the Patient’s Action Group, representing 126 of Eljamel’s patients calling for a public inquiry into how he was able to harm so many patients at NHS Tayside. Read full story (paywalled) Source: The Times, 25 July 2023 -
News ArticleAn award-winning hospital consultant says he has been “hunted” out of the NHS after 43 years for flagging patient safety failings. Peter Duffy, 61, performed his final surgical procedure, supervising a bladder cancer removal, earlier this month at Noble’s Hospital on the Isle of Man. He said he had “been looking forward to a good few more years of full-time work — another five, at least”. But the cumulative toll of a long-running whistleblowing dispute with his former employer, Morecambe Bay NHS Trust (UHMBT), instead pushed him into “an abrupt, even savage termination of my calling”. The General Medical Council watchdog recently dropped a 30-month probe into Duffy prompted by emails that he alleges were falsified. The emails, which were apparently sent by Duffy in December 2014 but did not surface until 2020, appeared to implicate him in the string of clinical errors that led to the death of Peter Read, a 76-year-old man from Morecambe. The GMC concluded that it could not attach weight to the emails as evidence. However, Duffy says the ordeal of “having the responsibility for an avoidable death I’d reported being flipped and of having the finger pointed back at me” drove him to contemplate suicide. Read full story (paywalled) Source: The Times, 24 July 2023
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Content ArticleIn this blog post, Kath Sansom, founder of the Sling the Mesh campaign, looks at the issue of payments being made to doctors and lobby groups by pharma and medical tech companies. She argues that these payments are a patient safety concern as it can lead to doctors displaying bias in advising treatments, with benefits being overstated and risks downplayed. This is especially concerning when industry money is given to consultants or researchers trialling new treatments. Kath highlights an investigation carried out by the Observer into the issue and explains why Sling the Mesh have lobbied the UK Government for a UK Sunshine style payment act, which would allow the public to look up the names of doctors, surgeons and researchers to see if they have taken money from industry.
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News Article
Robots-led surgeries could boost efficiency and free up beds, say surgeons
Patient Safety Learning posted a news article in News
Using robots to assist in operations could make surgery more efficient and free up NHS beds, a report has suggested. The Royal College of Surgeons of England (RCS England) has published a guide: Robotic Assisted Surgery – a pathway to the future; exploring the potential benefits and challenges of the technology. It said the document “provides a structured pathway” for surgeons who want to transition to robotic-assisted surgery, which allows doctors to operate with more precision using interactive, mechanical arms. The report outlined “significant advantages” of using robots in surgery, including reduced post-op pain, fewer blood transfusions, more efficient use of anaesthetics and shorter hospital stays for patients. There are also benefits when it comes to patient safety, the college said, with platforms eliminating tremors and providing a magnified image of the surgical site. Read full story Source: The Independent, 14 July 2023 -
News Article
Former surgeon wants NHS MeToo movement for sexual harassment
Patient Safety Learning posted a news article in News
A former breast cancer surgeon has said the NHS needs a MeToo movement because of sexual harassment in hospitals. Dr Liz O'Riordan said she experienced sexual harassment from colleagues on a weekly to monthly basis in some of her jobs as a junior doctor. In her first week as a junior doctor, she recalled a colleague asking if she "got an erection" after removing an 11-year-old boy's appendix. "We need to be able to say this is not good enough," said Dr O'Riordan. "When you are a trainee in a practical field, you are relying on your boss to let you operate to show you how to cut; it is a craft that you learn." "Basically you are naked in scrubs stood from shoulder, to hip, to knee, next to someone all squeezed in; a lot of body contact; you are relying on them to let you cut, and if you call them out they may say 'I don't like you, you are not coming to theatre today'. "It's very, very, very hard to stand up for yourself and say 'that is not on' and the minute you let them get away with it, it is accepted and they can carry on getting away with it." Read full story Source: BBC News, 12 July 2023 Related reading on the hub: Under the knife: Life Lessons from the operating theatre by Liz O’Riordan Calling out the sexist and misogynist culture within healthcare: a blog by Dr Chelcie Jewitt, co-founder of the Surviving in Scrubs campaign -
News Article
Ian Paterson: Eleven further inquests set to open
Patient Safety Learning posted a news article in News
A further 11 inquests are to be opened this week as part of an investigation into dozens of deaths linked to jailed breast surgeon Ian Paterson. Paterson is currently serving a 20-year sentence after he carried out unnecessary or unapproved procedures on more than 1,000 breast cancer patients. Judge Richard Foster said 417 cases of former patients had been reviewed. The inquests will open and be adjourned on Friday. More than 30 deaths are already the subject of an inquest. Paterson worked at Spire Parkway Hospital and Spire Little Aston Hospital in the West Midlands between 1997 and 2011, as well as NHS hospitals run by the Heart of England NHS Foundation Trust. Paterson was jailed in 2017 after being convicted of 17 counts of wounding with intent. An independent inquiry found he had been free to perform harmful surgery in NHS and private hospitals due to "a culture of avoidance and denial" in a healthcare system where there was "wilful blindness" to his behaviour. Read full story Source: BBC News, 10 July 2023 -
Content ArticleDr Liz O’Riordan is a breast cancer surgeon who has battled against social, physical and mental challenges to practise at the top of her field. Under the Knife charts Liz’s incredible highs: performing like a couture dressmaker as she moulded and reshaped women’s breasts, while saving their lives; to the heart-breaking lows of telling ten women a day that they had cancer. But this memoir is more than just an eye-opening look at the realities of training to be a female surgeon in a man’s world. In addition to this high-powered, high-pressured role, Liz faced her own breast cancer diagnosis, severe depression and suicidal thoughts, in tandem with commonplace sexual harassment and bullying. And by revealing how she coped when her life crashed around her, she demonstrates there is always hope.
