- Email: [email protected]
THE DEFENCE ORGANISATIONS
729
largely responsible. The solution to the problem of time off is being found increasingly in partnership and group practice. These also allow sharing of the cost of equipping and staffing the practice premises: and " the modern doctor ought not to be left to labour alone without help and without modern tools as a cottage industry ". The report welcomes the plan for a General Practice Advisory Service to help doctors over matters such as building materials and storage space in their premises; if the traditional distrust of the practitioner for the regional medical officer could be overcome, the latter could properly supply similar advice. Interest-free loans should be readily available to practitioners for practice improvements, and premises, once equipped, should be fully used. Surgery hours are usually only a few in each day; between them the accommodation could be used by, for instance, local-authority clinics. The subcommittee is unanimous in recommending the intelligent use of an appointment ’
system.
-
CONCLUSION
The subcommittee believes that the family doctor can be rescued from his isolation in the Health Service without any change in the tripartite administrative structure of the service. Some such change might subsequently result from increasing functional unification-unification which the family doctor has unique opportunities of
promoting. THE work of the English defence organisations continued to expand during 1962. MEDICAL DEFENCE UNION
Membership of the Union reached a record 50,000 and in the course of the year, 1 member in 16 wrote asking for advice. The advisory and educative activities of the Union are those which have developed most dramatically. This is reflected in its report for the year.1 The Union has, for instance, in conjuction with the Royal College of Nursing, drawn up a memorandum on the retained surgical swab. 38 actions for negligence on this account were handled by the union in 1962. The document emphasises that a surgeon who relies solely the nurses’ count does not discharge his responsibility: he himself must " take such additional precautions as are reasonable ". Analysis of past incidents shows that factors predisposing to the retention of swabs, packs, or instruments include working under pressure of time, unfamiliarity of nurse or surgeon with the routine of a particular theatre, and change in the theatre personnel during an operation. To guard against this type of accident the surgeon’s cooperation is essential in performing a final check before closure; and he should abandon his conviction that " it can’t happen to me ". on
The Union has also been considering the question of for operative treatment. The wording of many consent current forms, it says, needs revision: whether the " blank cheque " type used by some hospitals would protect the surgeon in the event of an action for assault is consent
doubtful. Since the publication of an article on " human guineapigs ", the Union has repeatedly been asked by practitioners to advise on the use of new forms of treatment.
Nowadays
a doctor is expected to apply the latest treatwhich could reasonably benefit his patient. Whatever the circumstances, says the report, the test is what is reasonable.
ment
obtainable from the Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1.
Copies
Society also reports2 excursion into the educative sphere in 1962-namely, the inauguration of a series of lectures on the medicolegal aspects of medical and dental practice. It draws attention once more to the importance which may attach to accurate contemporaneous records in
action for
an
damages:
"
The trial of an action often takes place some years after the giving rise to it, when the memories of the parties and of witnesses may well have become dimmed or less reliable.... The final result of an action ... may depend on the existenceor absence-of an entry made at the time in the patient’s records. If a certain course of treatment is advised which the patient declines to undergo, it is essential to record this fact in the notes." events
The
Society’s report includes an of inaccurate diagnosis. arising
account
of
a
case
out
A man was thrown from his bicycle because of negligence on the part of the local authority’s road-sweeper. He successfully claimed S125 from the authority for his injuries. Subsequently his condition was found to be more serious than had been thought, and he therefore claimed damages for negligence against the hospital which had first treated him and on whose assessment his first claim had been based. The judge disallowed his claim for lost damages since a doctor was not required, when examining a patient, to foresee any question connected with a third party’s liability to that
patient.
THE DEFENCE ORGANISATIONS
1.
MEDICAL PROTECTION SOCIETY
The
In
fully
a second case, allegations of negligence were successrefuted because of conflicting medical opinion.
lorry driver injured his right leg in a road accident. He to hospital, where fractures of the right tibia and third, fourth, and fifth metatarsals were confirmed by X-ray. All wounds were excised and a plaster was applied to the groin. Three weeks later the plaster was changed, the position checked radiologically, and the patient sent home on crutches. Six weeks later he started weight-bearing but immediately felt great pain and returned to the hospital. Dislocation of the hip was diagnosed at once, and subsequently treated by surgery. The man later claimed damages from the hospital, asserting that, for lack of proper examination, treatment of the dislocation had been delayed nine weeks. Experts testified on his behalf that classical signs of the dislocation must have been present on his first admission. The judge, however, preferred the explanation put forward on behalf of the defendant-that, A
was
taken
with fracture of the rim of the acetabulum, an initial transient dislocation had corrected itself but recurred as soon as weightbearing was resumed.
Public Health Anthrax of anthrax in Huddersfield for thirty years were reported this week.3 Of 2 confirmed cases, 1 proved fatal. A 3rd suspected case, a man who is now in the Bradford Isolation Hospital, was said to be not seriously ill. Fellow-workers in the woollen scouring mills, where the infection was contracted, have now been vaccinated, and the Medical Officer of Health for Huddersfield, Dr. William Turner, said that there need be no fear about the spread of the disease. THE first
cases
More
Non-smoking Compartments
London Transport is providing more accommodation for non-smokers on the Underground. For an experimental period 6-coach trains on the Circle Line and the Hammersmith and City Line will have 4 coaches for non-smokers. 2.
are
3.
Copies are obtainable from Street, London, W.1. Guardian, Sept. 30, 1963.
the Medical Protection
Society, 50, Hallam
largely responsible. The solution to the problem of time off is being found increasingly in partnership and group practice. These also allow sharing of the cost of equipping and staffing the practice premises: and " the modern doctor ought not to be left to labour alone without help and without modern tools as a cottage industry ". The report welcomes the plan for a General Practice Advisory Service to help doctors over matters such as building materials and storage space in their premises; if the traditional distrust of the practitioner for the regional medical officer could be overcome, the latter could properly supply similar advice. Interest-free loans should be readily available to practitioners for practice improvements, and premises, once equipped, should be fully used. Surgery hours are usually only a few in each day; between them the accommodation could be used by, for instance, local-authority clinics. The subcommittee is unanimous in recommending the intelligent use of an appointment ’
system.
-
CONCLUSION
The subcommittee believes that the family doctor can be rescued from his isolation in the Health Service without any change in the tripartite administrative structure of the service. Some such change might subsequently result from increasing functional unification-unification which the family doctor has unique opportunities of
promoting. THE work of the English defence organisations continued to expand during 1962. MEDICAL DEFENCE UNION
Membership of the Union reached a record 50,000 and in the course of the year, 1 member in 16 wrote asking for advice. The advisory and educative activities of the Union are those which have developed most dramatically. This is reflected in its report for the year.1 The Union has, for instance, in conjuction with the Royal College of Nursing, drawn up a memorandum on the retained surgical swab. 38 actions for negligence on this account were handled by the union in 1962. The document emphasises that a surgeon who relies solely the nurses’ count does not discharge his responsibility: he himself must " take such additional precautions as are reasonable ". Analysis of past incidents shows that factors predisposing to the retention of swabs, packs, or instruments include working under pressure of time, unfamiliarity of nurse or surgeon with the routine of a particular theatre, and change in the theatre personnel during an operation. To guard against this type of accident the surgeon’s cooperation is essential in performing a final check before closure; and he should abandon his conviction that " it can’t happen to me ". on
The Union has also been considering the question of for operative treatment. The wording of many consent current forms, it says, needs revision: whether the " blank cheque " type used by some hospitals would protect the surgeon in the event of an action for assault is consent
doubtful. Since the publication of an article on " human guineapigs ", the Union has repeatedly been asked by practitioners to advise on the use of new forms of treatment.
Nowadays
a doctor is expected to apply the latest treatwhich could reasonably benefit his patient. Whatever the circumstances, says the report, the test is what is reasonable.
ment
obtainable from the Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1.
Copies
Society also reports2 excursion into the educative sphere in 1962-namely, the inauguration of a series of lectures on the medicolegal aspects of medical and dental practice. It draws attention once more to the importance which may attach to accurate contemporaneous records in
action for
an
damages:
"
The trial of an action often takes place some years after the giving rise to it, when the memories of the parties and of witnesses may well have become dimmed or less reliable.... The final result of an action ... may depend on the existenceor absence-of an entry made at the time in the patient’s records. If a certain course of treatment is advised which the patient declines to undergo, it is essential to record this fact in the notes." events
The
Society’s report includes an of inaccurate diagnosis. arising
account
of
a
case
out
A man was thrown from his bicycle because of negligence on the part of the local authority’s road-sweeper. He successfully claimed S125 from the authority for his injuries. Subsequently his condition was found to be more serious than had been thought, and he therefore claimed damages for negligence against the hospital which had first treated him and on whose assessment his first claim had been based. The judge disallowed his claim for lost damages since a doctor was not required, when examining a patient, to foresee any question connected with a third party’s liability to that
patient.
THE DEFENCE ORGANISATIONS
1.
MEDICAL PROTECTION SOCIETY
The
In
fully
a second case, allegations of negligence were successrefuted because of conflicting medical opinion.
lorry driver injured his right leg in a road accident. He to hospital, where fractures of the right tibia and third, fourth, and fifth metatarsals were confirmed by X-ray. All wounds were excised and a plaster was applied to the groin. Three weeks later the plaster was changed, the position checked radiologically, and the patient sent home on crutches. Six weeks later he started weight-bearing but immediately felt great pain and returned to the hospital. Dislocation of the hip was diagnosed at once, and subsequently treated by surgery. The man later claimed damages from the hospital, asserting that, for lack of proper examination, treatment of the dislocation had been delayed nine weeks. Experts testified on his behalf that classical signs of the dislocation must have been present on his first admission. The judge, however, preferred the explanation put forward on behalf of the defendant-that, A
was
taken
with fracture of the rim of the acetabulum, an initial transient dislocation had corrected itself but recurred as soon as weightbearing was resumed.
Public Health Anthrax of anthrax in Huddersfield for thirty years were reported this week.3 Of 2 confirmed cases, 1 proved fatal. A 3rd suspected case, a man who is now in the Bradford Isolation Hospital, was said to be not seriously ill. Fellow-workers in the woollen scouring mills, where the infection was contracted, have now been vaccinated, and the Medical Officer of Health for Huddersfield, Dr. William Turner, said that there need be no fear about the spread of the disease. THE first
cases
More
Non-smoking Compartments
London Transport is providing more accommodation for non-smokers on the Underground. For an experimental period 6-coach trains on the Circle Line and the Hammersmith and City Line will have 4 coaches for non-smokers. 2.
are
3.
Copies are obtainable from Street, London, W.1. Guardian, Sept. 30, 1963.
the Medical Protection
Society, 50, Hallam