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This is a horror story for a parent to read. Preventable death of a 13 yr old girl, just starting her life. Tears swelled in my eyes. And yet, I am convinced th

This is a horror story for a parent to read. Preventable death of a 13 yr old girl, just starting her life. Tears swelled in my eyes. And yet, I am convinced that the NHS “system” does not care in the end. Diluted responsibility of a bureaucratic setup, where doctors are incentivized to follow protocols and protect themselves from liabilities. No reward for going above and beyond, no punishment for not caring. And we keep edging towards more of this all over the world. I think this is an example of the costs we will pay.

jsmith99 4y ago
How do other systems reward doctors who 'go beyond' or punish those who don't care?
- kurupt213 4y ago
  This is why medical malpractice is a healthy part of the system. Bad doctors become too toxic to be employable. Another check in the system. Killing children through gross negligence should be career ending. This is exactly why PAs and NPs should always be under the supervision of an attending, and why MDs can’t practice unsupervised until they have 10,000+ hours of on the job training
  - pmyteh 4y ago
    If it's actually gross negligence then it's not just potentially career ending in England and Wales, it's potentially imprisonable (manslaughter by gross negligence, max penalty life imprisonment). You're also entirely liable to being sacked and being struck off the medical register. And the victim's family can and will win a medical malpractice claim against the hospital here (albeit probably for less money than the US: the big payouts here are for cases where long term care is needed). What we need are better staffing ratios and a proper process for designing out error. The Healthcare Safety Investigation Branch[0] has set out to do for hospitals what the Air Accidents Investigation Branch and NTSB do for aviation safety. Let's hope it helps. [0]: https://www.hsib.org.uk/ https://www.hsib.org.uk/
- origin_path 4y ago
  Private sector systems: 1. Find it easier to promote based on skill rather than tenure. 2. Can give bonuses or fire bad employees. 3. Are incentivized to avoid horrible outcomes like this for PR/financial reasons alone beyond just the ethical issues. 4. Are also incentivized to avoid it due to liability lawsuits. None of these incentives or systems really apply to the NHS. In this case the problems seemed to be more like general management and staff dysfunction rather than a need to reward "going beyond". Constant rotation of doctors instead of assigning the patient to a single doctor, some of whom were in training, over confidence, refusal to make backup plans, apparent inability to recognize sepsis even in the most extreme stages and consequent refusal to escalate to ICU, keeping the parents and patients out of the loop, working from home despite being on call, apparent inability to preserve records, promoting a doctor just weeks after he made critical mistakes etc. In other words - rampant and systemic incompetence. The problems here were seriously compounded by a dysfunctional aspect of British culture in which the NHS is practically worshipped, and treating it cynically is deemed a severe moral failing (I'm British, I've seen this first hand). The article dwells on this near the start. Several times the mother correctly diagnose the fact that there are serious problems with their child's care and each time is basically told to shut up and Trust The NHS, which she then meekly does. It's easy to imagine American parents at this point starting to threaten lawsuits, switch hospitals, remind doctors that they're the 'customer' or take other concrete actions to express their displeasure but none of this is available to Brits.
  - jsmith99 4y ago
    Consultant roles in the NHS are competitive and are not simply based on tenure. Doctors often switch hospitals exactly as if this was the private sector, as NHS hospitals can compete against each other for staff. The NHS internal market system means the individual hospitals are very financially driven. The NHS also pays huge amounts on clinical negligence claims (they have a £60bn provision) although this is managed centrally - effectively the central NHS Resolution organisation is insuring individual hospitals in return for charging a levy.
  - DanBC 4y ago
    What on earth makes you think this hospital could not fire the responsible healthcare professionals?

jsmith99 4y ago

How do other systems reward doctors who 'go beyond' or punish those who don't care?

kurupt213 4y ago
This is why medical malpractice is a healthy part of the system. Bad doctors become too toxic to be employable. Another check in the system. Killing children through gross negligence should be career ending. This is exactly why PAs and NPs should always be under the supervision of an attending, and why MDs can’t practice unsupervised until they have 10,000+ hours of on the job training
- pmyteh 4y ago
  If it's actually gross negligence then it's not just potentially career ending in England and Wales, it's potentially imprisonable (manslaughter by gross negligence, max penalty life imprisonment). You're also entirely liable to being sacked and being struck off the medical register. And the victim's family can and will win a medical malpractice claim against the hospital here (albeit probably for less money than the US: the big payouts here are for cases where long term care is needed). What we need are better staffing ratios and a proper process for designing out error. The Healthcare Safety Investigation Branch[0] has set out to do for hospitals what the Air Accidents Investigation Branch and NTSB do for aviation safety. Let's hope it helps. [0]: https://www.hsib.org.uk/ https://www.hsib.org.uk/
origin_path 4y ago
Private sector systems: 1. Find it easier to promote based on skill rather than tenure. 2. Can give bonuses or fire bad employees. 3. Are incentivized to avoid horrible outcomes like this for PR/financial reasons alone beyond just the ethical issues. 4. Are also incentivized to avoid it due to liability lawsuits. None of these incentives or systems really apply to the NHS. In this case the problems seemed to be more like general management and staff dysfunction rather than a need to reward "going beyond". Constant rotation of doctors instead of assigning the patient to a single doctor, some of whom were in training, over confidence, refusal to make backup plans, apparent inability to recognize sepsis even in the most extreme stages and consequent refusal to escalate to ICU, keeping the parents and patients out of the loop, working from home despite being on call, apparent inability to preserve records, promoting a doctor just weeks after he made critical mistakes etc. In other words - rampant and systemic incompetence. The problems here were seriously compounded by a dysfunctional aspect of British culture in which the NHS is practically worshipped, and treating it cynically is deemed a severe moral failing (I'm British, I've seen this first hand). The article dwells on this near the start. Several times the mother correctly diagnose the fact that there are serious problems with their child's care and each time is basically told to shut up and Trust The NHS, which she then meekly does. It's easy to imagine American parents at this point starting to threaten lawsuits, switch hospitals, remind doctors that they're the 'customer' or take other concrete actions to express their displeasure but none of this is available to Brits.
- jsmith99 4y ago
  Consultant roles in the NHS are competitive and are not simply based on tenure. Doctors often switch hospitals exactly as if this was the private sector, as NHS hospitals can compete against each other for staff. The NHS internal market system means the individual hospitals are very financially driven. The NHS also pays huge amounts on clinical negligence claims (they have a £60bn provision) although this is managed centrally - effectively the central NHS Resolution organisation is insuring individual hospitals in return for charging a levy.
- DanBC 4y ago
  What on earth makes you think this hospital could not fire the responsible healthcare professionals?