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A FATAL X RAY ACCIDENT
777 A FATAL X RAY ACCIDENT To the Editor of THE LANCET
SIR,-I have read with much interest Dr. Burkitt’s detailed account of the deplorable X ray fatality at Wimbledon Hospital. As an X ray operator of long experience who has held the diploma of the
Society
of
permitted
Radiographers since 1922, may I a protest z Dr. Burkitt says
to enter
be
:-
"It is not suggested, I presume, that all the radiography is to be done in the presence of the radiologist, since this would be impossible under present circumstances, and it is for this reason that we train radiographers to do the actual radiography by themselves."
This is just the trouble. Nurses, masseuses, and what not are sent to X ray departments to "help " and gain, after some months (sometimes years), a certain sleight of hand in making the adjustments of kilovoltage and milliamperage appropriate to the particular set installed, and in pulling out the right exposure switches. But send them to a new department in a different hospital where different conditions obtain and they are completely at sea; or if anything occurs that requires deviation from the usual routine in working their own sets, their parrot-like attitude goes by the board. I have seen and checked some terrifying procedures
by people with long practical experience but no theory behind it. In wards particularly, there is a dangerous slackness about making safe adjustments. The X ray tube is apt to be placed too near the bed rail (head bed rails should be removable), a frequent cause both of shattering the tube and of charging the bed. Another practice dangerous to bystanders is the slovenly habit of attaching tube leads to chairs.
earthed
Ordinarily with the use of the modern
apparatus
the
accident
at
Wimbledon
Hospital should have been impossible ; but the nurse courted disaster by disregarding orders. I am very glad to see Dr. Burkitt insisting on the implicit obedience essential in an X ray department. It should be rendered quite apart from hospital rank, and rendered whether the order comes from the radiologist, the X ray sister, or the male radiographer in charge. One simply must dissociate rule of thumb from the plotting out either of dosage or diagnostic exposures in X ray work. What we qualified radiographers really need is State registration to protect our profession and safeguard the public. I am, Sir, yours faithfully, AILEEN H.
MOORE, S.R.N., M.S.R.
Chelsea, S.W., Sept. 22nd, 1933.
PANEL AND CONTRACT PRACTICE A
Survey Sir George
of the Insurance Medical Service
Newman’s report on. the State of the Public Health for the year 1932 reminds us that the national health insurance scheme has now been working 21 years, and that the time is opportune to take stock of the position of the wage-earners of this country in respect of medical attention to-day compared with their position before the inception of the scheme. He points out that prior to 1913 medical needs were supplied to the more poorly paid workers by charity, to the better paid workers by clubs associated with trade-unions or friendly societies, and that in many instances the conditions under which the appointed practitioners served were far from conducive to good medical work ; whereas to-day more than one-third of the total population are entitled by statute to a standard of service which no disinterested observer doubts is superior to that given before the passing of the first National Insurance Act. This service is what the average citizen looks to his family doctor to provide, and, except under certain additional benefit regulations, does not include specialist services. General practitioner services however advance, and methods of treatment are now available which were unknown a few years ago. Every effort, Sir George says, will be made to improve still further the standard of clinical work done ; one of the chief means to this end consists in reasonably full clinical records of illness. Whilst it is difficult to give demonstrable proof of the quality of this work, yet the number of complaints by insured persons to insurance committees regarding attention and treatment is negligible in relation to the size of the service, and that in spite of the fact that each insured person is informed on the card supplied to him that " any inquiry or complaint ... should be addressed to the clerk to the insurance committee " at an address given. Further testimony is afforded by the regional medical officers who are in daily touch with practitioners and insured persons, and have unique opportunity of appraising the standard of work attained. Their experience is
that, except in the case of a small minority of practi- tioners, the standard is not only high but is steadily the former disadvantages practice. Again information reaching the Ministry through medical officers of health leaves Sir George in no doubt that much of the gratifying improvement in the general public health is due to the increasing efficiency of practitioners.
advancing
and without
of contract
The number of insured persons has increased from
15,803,000 in 1931 to 16,010,000 in 1932 ; the number of practitioners from 15,764 in 1931 to 16,783 in 1932. Of the insured persons 819,501 had not made
arrangements for joining a doctor’s list. The cost of medical benefit, excluding administration,,amounted to 8,961,936, of which 6,734,050 was paid to practitioners, the remainder being spent on medicines and appliances. The supervision of prescribing is adopted solely to eliminate waste and not in any way to restrict the amount expended upon treatment. Each insurance practitioner is entirely free and is indeed under obligation to adopt the line of treatment and to order those medicines he considers best in the interests of the patient. When dealing with excessive cost an interview with friendly discussion between the regional medical officer and the practitioner in the first instance is still the policy of the Ministry; 945 practitioners were visited in 1932 as compared with 1427 in 1931, and in only one case was a deduction authorised. The responsibility for the payment of a claim for sickness benefit rests with the approved society, and by far the most important piece of evidence is the practitioner’s certificate of incapacity. The majority of practitioners are fully alive to their responsibility to the approved society and discharge it faithfully ; there is evidence that the number falling short in these respects is decreasing. Such practitioners are interviewed by the regional medical staff and in most cases expressed their appreciation of the help gained in the discussion of these cases. As the duty of safeguarding the funds is in the hands of approved societies and they in turn depend upon the information supplied by doctors, it is very desirable
SIR,-I have read with much interest Dr. Burkitt’s detailed account of the deplorable X ray fatality at Wimbledon Hospital. As an X ray operator of long experience who has held the diploma of the
Society
of
permitted
Radiographers since 1922, may I a protest z Dr. Burkitt says
to enter
be
:-
"It is not suggested, I presume, that all the radiography is to be done in the presence of the radiologist, since this would be impossible under present circumstances, and it is for this reason that we train radiographers to do the actual radiography by themselves."
This is just the trouble. Nurses, masseuses, and what not are sent to X ray departments to "help " and gain, after some months (sometimes years), a certain sleight of hand in making the adjustments of kilovoltage and milliamperage appropriate to the particular set installed, and in pulling out the right exposure switches. But send them to a new department in a different hospital where different conditions obtain and they are completely at sea; or if anything occurs that requires deviation from the usual routine in working their own sets, their parrot-like attitude goes by the board. I have seen and checked some terrifying procedures
by people with long practical experience but no theory behind it. In wards particularly, there is a dangerous slackness about making safe adjustments. The X ray tube is apt to be placed too near the bed rail (head bed rails should be removable), a frequent cause both of shattering the tube and of charging the bed. Another practice dangerous to bystanders is the slovenly habit of attaching tube leads to chairs.
earthed
Ordinarily with the use of the modern
apparatus
the
accident
at
Wimbledon
Hospital should have been impossible ; but the nurse courted disaster by disregarding orders. I am very glad to see Dr. Burkitt insisting on the implicit obedience essential in an X ray department. It should be rendered quite apart from hospital rank, and rendered whether the order comes from the radiologist, the X ray sister, or the male radiographer in charge. One simply must dissociate rule of thumb from the plotting out either of dosage or diagnostic exposures in X ray work. What we qualified radiographers really need is State registration to protect our profession and safeguard the public. I am, Sir, yours faithfully, AILEEN H.
MOORE, S.R.N., M.S.R.
Chelsea, S.W., Sept. 22nd, 1933.
PANEL AND CONTRACT PRACTICE A
Survey Sir George
of the Insurance Medical Service
Newman’s report on. the State of the Public Health for the year 1932 reminds us that the national health insurance scheme has now been working 21 years, and that the time is opportune to take stock of the position of the wage-earners of this country in respect of medical attention to-day compared with their position before the inception of the scheme. He points out that prior to 1913 medical needs were supplied to the more poorly paid workers by charity, to the better paid workers by clubs associated with trade-unions or friendly societies, and that in many instances the conditions under which the appointed practitioners served were far from conducive to good medical work ; whereas to-day more than one-third of the total population are entitled by statute to a standard of service which no disinterested observer doubts is superior to that given before the passing of the first National Insurance Act. This service is what the average citizen looks to his family doctor to provide, and, except under certain additional benefit regulations, does not include specialist services. General practitioner services however advance, and methods of treatment are now available which were unknown a few years ago. Every effort, Sir George says, will be made to improve still further the standard of clinical work done ; one of the chief means to this end consists in reasonably full clinical records of illness. Whilst it is difficult to give demonstrable proof of the quality of this work, yet the number of complaints by insured persons to insurance committees regarding attention and treatment is negligible in relation to the size of the service, and that in spite of the fact that each insured person is informed on the card supplied to him that " any inquiry or complaint ... should be addressed to the clerk to the insurance committee " at an address given. Further testimony is afforded by the regional medical officers who are in daily touch with practitioners and insured persons, and have unique opportunity of appraising the standard of work attained. Their experience is
that, except in the case of a small minority of practi- tioners, the standard is not only high but is steadily the former disadvantages practice. Again information reaching the Ministry through medical officers of health leaves Sir George in no doubt that much of the gratifying improvement in the general public health is due to the increasing efficiency of practitioners.
advancing
and without
of contract
The number of insured persons has increased from
15,803,000 in 1931 to 16,010,000 in 1932 ; the number of practitioners from 15,764 in 1931 to 16,783 in 1932. Of the insured persons 819,501 had not made
arrangements for joining a doctor’s list. The cost of medical benefit, excluding administration,,amounted to 8,961,936, of which 6,734,050 was paid to practitioners, the remainder being spent on medicines and appliances. The supervision of prescribing is adopted solely to eliminate waste and not in any way to restrict the amount expended upon treatment. Each insurance practitioner is entirely free and is indeed under obligation to adopt the line of treatment and to order those medicines he considers best in the interests of the patient. When dealing with excessive cost an interview with friendly discussion between the regional medical officer and the practitioner in the first instance is still the policy of the Ministry; 945 practitioners were visited in 1932 as compared with 1427 in 1931, and in only one case was a deduction authorised. The responsibility for the payment of a claim for sickness benefit rests with the approved society, and by far the most important piece of evidence is the practitioner’s certificate of incapacity. The majority of practitioners are fully alive to their responsibility to the approved society and discharge it faithfully ; there is evidence that the number falling short in these respects is decreasing. Such practitioners are interviewed by the regional medical staff and in most cases expressed their appreciation of the help gained in the discussion of these cases. As the duty of safeguarding the funds is in the hands of approved societies and they in turn depend upon the information supplied by doctors, it is very desirable