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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
Cosmetic surgeon is suspended for series of failures in patient care
Patient Safety Learning posted a news article in News
A cosmetic surgeon has been suspended from the UK medical register for nine months for failures in obtaining informed consent, pressuring a patient into surgery by offering a discount, and laughing when passing on a patient’s complaint of sexual assault by another doctor. Ashish Dutta is the nominated member for the European Society of Aesthetic Surgery on the European Commission for Standardisation of Aesthetic Surgery Services. He is also an examiner for the World Board of Cosmetic Surgery. Read full story (paywalled) Source: BMJ, 27 November 2019 -
News Article
Cosmetic surgeon struck off after botched ops
Patient Safety Learning posted a news article in News
A cosmetic surgeon who did not have adequate insurance for operations that went wrong has been struck off. Dr Arnaldo Paganelli worked privately for The Hospital Group in Birmingham. The Medical Practitioners' Tribunal Service ruled his actions constituted misconduct. Four women took their case to the body and the tribunal heard evidence about his time at Birmingham's Dolan Park Hospital where he made regular trips from Italy to work. Lead campaigner Dawn Knight, from Stanley, County Durham, said too much skin was removed from her eyes during an eyelift in 2012 and they became "constantly sore". She told BBC Radio 4's You and Yours programme she felt relieved Dr Paganelli "cannot injure anyone else on UK soil" and called for the government to tighten regulation around cosmetic procedures to protect the public. "The process has been long, emotional and exhausting. This situation must never be repeated. After all, when are you more vulnerable than when under aesthetic at the hands of a surgeon who has no insurance?" Read full story Source: BBC News, 12 August 2020 -
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 ArticleA Bristol woman says her life has 'never been the same' since receiving unnecessary operations on her bowel more than ten years ago. Following a recent review, Mandy Giltrow is one of more than 200 patients who received a mesh bowel procedure - which she says may not have been needed. The operations were all conducted by surgeon Tony Dixon who has been sacked by the North Bristol NHS Trust. Mandy Giltrow underwent a mesh bowel procedure which was performed by Mr Dixon at Frenchay Hospital in April 2011. Following the surgery her symptoms continued. Following follow up appointments Mandy, a mum-of-four, underwent a further procedure in April 2013. Mr Dixon carried out a further operation in October 2014 at Spire Bristol to replace mesh. However Mandy, who is 49 and lives in Staple Hill, continues to suffer issues including stomach and bowel pain as well as recurrent water infections. She also has a hernia near her surgery scars. North Bristol NHS Trust has since admitted liability. Mandy told ITV West Country: "I got anxiety for all the different operations I had and then I physically could not do anything. I was stuck for three months in a bubble." "I couldn't go out, I couldn't do anything with my children not even take them to school." Mandy says her mental health was badly affected by the operations leading to a nervous breakdown and agoraphobia, meaning she could not lead the house. "You have an operation. It doesn't resolve the original problem and now you have another problem which is twice as bad." Read full story Source: ITV, 30 May 2022
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News Article
Bristol surgeon ‘harmed’ 203 women with unnecessary operations
Patient Safety Learning posted a news article in News
More than 200 women were harmed when a rogue surgeon carried out operations on them unnecessarily, an NHS inquiry has found. Some of the women were left with life-changing physical problems or unable to work, while many also suffered trauma and serious psychological harm as a result. Overall, 203 women on whom Anthony Dixon performed procedures between 2007 and 2017 came to harm, according to a review by the North Bristol NHS trust (NBT). Dixon, who for years was Britain’s most influential pelvic surgeon, worked for both the trust and the private Spire hospital in the city. In 2017, NBT launched a review of Dixon’s performance and suspended him after dozens of women he had performed procedures on complained that they had experienced appalling consequences, including unmanageable pain and incontinence. The Guardian revealed in late 2017 that 100 women were suing him for medical negligence. Some cases have since been settled, but dozens are ongoing. NBT sacked Dixon in 2019 and he is currently banned from practising in the UK. During the review, 378 women were recalled and asked to set out their dealings with Dixon. All had undergone a procedure called laparoscopic ventral mesh rectopexy (LVMR), in which plastic mesh is inserted to repair weakened tissue in the pelvic floor. In papers presented to NBT’s board on Thursday, board members were told that the inquiry had concluded. “The trust has notified 203 NHS patients that, although their LVMR operation was carried out satisfactorily, they should have been offered alternative treatments before proceeding to surgery. We have defined these patients as suffering ‘harm’ as a result,” it said. Read full story Source: The Guardian, 26 May 2022 -
News ArticleHeart surgery patients in London have died “unnecessarily” and faced increased risk of death as botched NHS investigations into dozens of deaths reduced a hospital’s ability to treat people, a coroner has warned. “Unnecessary” patient deaths have occurred as a result of heart surgery at St George’s University Hospital Trust being restricted and emergencies diverted to other “over stretched” hospitals, following investigations by national NHS bodies. The warning that deaths have occurred and may occur in the future, comes following the conclusion of a series of inquest hearings in March, during which it was found the NHS’ wrongly blamed a team of cardiac surgeons for the deaths of dozens of patients. Coroner Fiona Wilcox, in a report published on Wednesday, has now said the “inadequate” NHS led investigations, which criticised the care of 67 patients, led to people being put increased risk of death. The NHS’ investigations into the deaths of 67 patients ruled there were “shortcomings” in care. It led to complex operations being diverted elsewhere and doctors being referred to the General Medical Council. Two doctors have sinced been exonerated following GMC hearings. According to the coroner’s findings, capacity within cardiac surgery at the unit is down by 60% and staff are becoming “deskilled.” Read full story Source: The Independent, 11 May 2022
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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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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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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
