I recently posted on this.
As it happened I attended a recent meeting of our provincial medical society and this whole issue was front and centre.
At the meeting the deceased father gave a moving but rational presentation on the events following his son's death. He has tried to put a positive face on his son's death that maybe this can prevent other events or near events. We learned that his son was an engineer and a pilot in other words an intelligent individual not some yahoo. Not that that should have made any difference to how he was treated. We also learned that he did indeed die of a pulmonary embolus. What he didn't say was what the emergency room doc who saw him the day before did to rule out a DVT.
Their take on the whole mess can be found here.
This generated much discussion. Much discussion was of course on looking for passive ways of improving communication and what almost nobody wanted to say was that unless we go back to the way we practised 20-30 years ago, we can expect similar events. One younger doctor did say that the doctors who graduated with him, universally expect to make large amounts of money for as little work as possible. That was when the President, an old GP came up with the statement in the title, which is essentially the social contract between doctors and society. His point was that you can't get rid of one stupid without getting rid of the other stupid. Part of the problem is the fact that 100 or so years ago we did agree to work so hard, which is why we have never set up systems to deal with problems during the day and after hours because there was never any need to because the hard-working doctor was always available.
As it happened I attended a recent meeting of our provincial medical society and this whole issue was front and centre.
At the meeting the deceased father gave a moving but rational presentation on the events following his son's death. He has tried to put a positive face on his son's death that maybe this can prevent other events or near events. We learned that his son was an engineer and a pilot in other words an intelligent individual not some yahoo. Not that that should have made any difference to how he was treated. We also learned that he did indeed die of a pulmonary embolus. What he didn't say was what the emergency room doc who saw him the day before did to rule out a DVT.
Their take on the whole mess can be found here.
This generated much discussion. Much discussion was of course on looking for passive ways of improving communication and what almost nobody wanted to say was that unless we go back to the way we practised 20-30 years ago, we can expect similar events. One younger doctor did say that the doctors who graduated with him, universally expect to make large amounts of money for as little work as possible. That was when the President, an old GP came up with the statement in the title, which is essentially the social contract between doctors and society. His point was that you can't get rid of one stupid without getting rid of the other stupid. Part of the problem is the fact that 100 or so years ago we did agree to work so hard, which is why we have never set up systems to deal with problems during the day and after hours because there was never any need to because the hard-working doctor was always available.
In face as people started to want to work less stupid hours they were able to do so because other people were still willing to work stupid hours and pick up their slack. GPs got out of the emergency rooms because other doctors were willing to work there leading in time to the specialty of emergency medicine. They got out of hospital medicine because specialists were willing to look after their patients for them. They got out of obstetrics because obstetricians could do normal deliveries for them. As specialists got sick of working, the hospitalist was invented meaning that really two doctors are now getting paid for what one doctor used to do. Medicentres enable docs to see large number of patients over a fixed shift with no long term follow-up. Specialists started to hive off the lucrative and easy parts of their practice, leaving the rest of the work for their not so smart (or more ethical) specialist brethren.
Remuneration is not a problem. We now have after hours premiums and retainers for being on call that I could only have dreamed of 30 years ago.
Not to complain but anaesthesia is one of the few specialties that actually works harder now than they did 30 years ago and we haven't figured out how to get hospitalists to do our work for us. A lot of us feel guilty the odd time we have to let a resident do an after hours case by himself (those of us who have residents).
The interesting thing about this case is that 30 years ago, not being able to contact his urologist would have been moot. He would have called the hospital switchboard or visited the emergency and would have been seen by the urology resident or by the rotating intern on the surgical service. Rotating interns are of course extinct and urology residents now take call from home. House staff worked really stupid hours for not so stupid money in the old days. Not saying that that was right and I support to a degree the more relaxed lifestyles residents have today. Problem is that as residents eased out of the medical workforce, especially the after hours work force, nobody thought who was going to pick up the slack and it certainly wasn't going to be the consultants.
Interesting times and it will be interesting to see how the medical profession in Albertafigures its way out of this problem or whether it is forced to do something by outside forces. It is again quite possible that we will just weather the storm until the next outrage.
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