Contact Your Financial Adviser MONEY MAKING MC
If a patient gets admitted to an emergency ward on a
weekend in the British hospitals s/he is worse off, as senior consultants do
not go for ward-rounds, to see the new admissions. So, many short-term
cross-sectional studies were carried out to sort this out; but, recently, the
editor of theBritish Medical Journal (BMJ) chose to write an
editorial about the subject wherein she was non-committal in deciding which way
the wind is blowing.
Disease is an accident and it cannot be programmed to hit
only on working days. The hospitals are adequately staffed by junior doctors
even on weekends. This was so even when I was an SHO (senior house officer),
registrar and SR (specialty registrar) in England decades ago. Most of the work
is done by the junior doctors anyway even on weekdays. The consultants were
there just to guide and help when we got stuck. They were on call even during
the weekends, if needed. I am told that now the consultants will have to work
harder as there are fewer junior doctors. All said and done, the brunt of
hospital disease management depends on the junior doctors. Under these
circumstances, what is our problem during the weekends?
What about the impact of fewer doctors on patients? A
14-country study showed that where there were more doctors per capita in the US
and Europe, but mortality was higher, health of the population worse and
longevity lower compared to countries with very few doctors per capita like in
Japan. (Journal of the American Medical Association 2000; 284: 483)
In addition, Japan had the best health indices with least mortality and
morbidity with less healthcare costs. Japan also had one more advantage: the
majority of doctors there were family physicians.
If we extrapolate those data here, weekend patients must
be the luckiest! When doctors went on strike in Israel a few years ago (2 BMJ
2000;320:1561), Bogota in Columbia and Saskatchewan in Canada, mortality and morbidity
did fall precipitously only to climb back to normal when doctors came back to
work in full strength! The five-star ICU almost next door to the War theatre in
Vietnam vis-à-vis almost nil medical facility in Falklands War
where the seriously injured soldiers, at times, were left on the snow for hours
to be airlifted to England, showed no statistically significant difference in
overall mortality with marginally better results in Falklands cases.
We need a good audit on what we do to patients in an emergency.
Nature has in-built mechanisms to keep a person alive after severe injury like
auto-transfusion, auto-infusion, autonomic system mediated redistribution of
the circulation, clotting cascade and supply of extra energy through
neo-glucogenesis and many other changes that we are yet to comprehend. As
pointed out by Mary Tinnetti, in her article End of Disease Era,
“The time has come to abandon disease as the focus of medical care. (American
Journal of Medicine 2004; 116: 179) The changed spectrum of health,
the complex interplay of biological and non-biological factors, the aging
population, and the inter-individual variability in health priorities, render
medical care that is centred on the diagnosis and treatment of individual
diseases, at best, out-of-date and, at worst, harmful. A primary focus on
disease may inadvertently lead to under-treatment, overtreatment, or
mistreatment... Clinical decision making for all patients should be predicated
on the attainment of individual goals and the identification and treatment of
all modifiable biological and non-biological factors, rather than solely on the
diagnosis, treatment, or prevention of individual diseases.” I couldn’t agree
more.
Our reductionist method of looking at weekend syndrome
does not give you clear answers adding to my argument that all is not well in
our knowledge base about human physiology, pathology and worse than them both
our faulty management strategies. Junior doctors are, in some ways, better
equipped to manage acute illness compared to specialists who are needed to
think deeply about vexing problems which need many bright heads to solve.
Otherwise, a specialist could complicate matters further. Let us get out of the
weekend mind-set to whole week problems in disease management!
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