- Email: [email protected]
THE DEFENCE SOCIETIES
773
vague, demanding, and often disgusting, doubly incontiand indifferent or unaware of it-and we accept " these, to the eternal credit of our geriatric nurses ". But we regard such a mental condition as temporary, requiring investigation and treatment of its cause, and we expect it to disappear as the patient improves. The doctors at The Bar have, from long experience, become very perceptive about such cases. They may be suspicious of a report of a patient wandering, and say to us : " We know you don’t usually take such patients, but the signs seem to us to point to serious illness." On the other hand, we cannot cope with aggressive noisy perpetually restless patients, who rove around the ward or scream from their cot-beds, striking the nurses, and shouting abuse at everyone. This behaviour would be alarming in any ward, but it is especially so to rational elderly people. Moreover, it is particularly disruptive to the routine of a geriatric unit, where the treatment ranges from blood-transfusions and drips for the very ill, to active rehabilitation with wheel-chairs, Zimmers, and Warrals for the convalescent. Again and again we have seen a problem patient, who has baffled us, quite transformed by a spell in a mental hospital-the mind soothed and restored to sanity by its atmosphere of calm, leisure, space, and freedom. And as for the acute mental patients to whom we refuse admission, surely the place for them is in the hands of the experts who have now so much to offer at all ages. The figure of 18% " not admitted " in the list of 1000 patients specially selected as most urgent, whom I visited from 1953 to 1961, remains much the same; for the year 1960 it was 17%. The proportion, which is not negligible, proves the continued need for our time-consuming task of "vetting the waiting-list ". A closer link with the general practitioners would no doubt help us to assess priority; but we should need more space and staff to deal with the constant telephone calls. Besides, the centralised system at The Bar carries with it the advantage of the right of appeal to other sources of accommodation when we are eager to admit but have no more beds. nent
I wish to thank Dr. W. F. Anderson for his constant encouragement ; the general practitioners who let us visit their patients; Dr. David Agnew and Dr. W. T. Rankin at The Bar; and the nursing staff of the geriatric unit at Stobhill, who have cheerfully and devotedly nursed so many of Glasgow’s elderly.
THE DEFENCE SOCIETIES Both English defence societies have the previous year’s activities.
lately reported
on
MEDICAL PROTECTION SOCIETY
At the society’s annual general meeting on Oct. 3, Dr. F. HARwooD STEVENSON, chairman of the council, spoke of instructions or rules issued by hospital authorities for junior medical staff: "When these deal with clinical matters over-simplification may be dangerous, and we have on one or two occasions found it necessary to undertake negotiations with hospital authorities to prevent unwitting interference with clinical judgment which might have resulted in danger to patients and consequent allegations against either the hospital or a doctor or
both." A further matter that gave trouble from time to time was the ease with which anterior teeth or crowns of teeth might be dislodged by some apparatus during anaesthesia. The old problem of suitable sites for injections continued to give trouble: It has to be remembered that "
there are very few suitable places, and the is not one of them." Harwood Stevenson suggested that sometimes Dr. in radiologists, making a negative report on an X-ray film, might usefully suggest either that further views be taken or that further films be taken later, if their experience led them to believe that such further investigation would be helpful. The cases described in the society’s annual reporti include one where an allegation of negligence in failing to diagnose fracture of the skull and intrathoracic injury was successfully resisted. in the
arm
triceps region
A shipyard worker, injured by a fall, was casualty officer who found several injuries
examined by a but no clinical intrathoracic injury. The
evidence of either intracranial or patient was sent home; and the following day an orthopaedic surgeon confirmed the casualty officer’s findings, applied treatment, and again sent the patient home. Next morning the patient died; and necropsy revealed a fractured base of skull with subsarachnoid haemorrhage, and fractures of the 5th-8th ribs on the left side with complete collapse of the left lung, the lower lobe having a small superficial laceration. The deceased man’s relatives brought an action for damages against the hospital alleging negligence by the hospital doctors in failing to diagnose the fractured skull and the intrathoracic damage, and in failing to admit the patient to hospital for observation. In the Court of Session judgment was delivered in favour of the defenders. The judge found that neither the subarachnoid bleeding nor the pneumothorax had manifested itself while the patient was at the hospital; and that " the evidence does not establish any practice of automatically detaining a man who has suffered a head injury (without losing consciousness) or a rib injury. Apart from practice reliance can only be placed on signs apparent at the time of the examination. It is not enough in order to establish negligence to show that other medical men would on those signs have acted differently." MEDICAL DEFENCE UNION
The annual report of the Medical Defence Union2 refers to the importance of case-notes : of the greatest value, not only when to another practitioner, but also in meeting any criticism that may arise. In many cases with which the Medical Defence Union is concerned, the notes are woefully inadequate. Those who teach students, housemen and assistants would render a great service to their profession if they would insist on proper note taking during and subsequent to their training. If a patient refuses to accept the advice of his practitioner it is most important that this fact should be recorded."
"... Good
handing
notes are
over a
patient
Among other subjects, the report discusses the question posed by a gynaecologist who proposed to attempt to graft a healthy ovary into the body of a young woman who had had both ovaries removed. "
If the operation was successful the patient after marriage become pregnant and the question was whether a child born of such pregnancy would be legitimate or illegitimate. Counsel’s opinion was obtained and he advised that the child would be illegitimate. A legitimate child is one conceived during wedlock by means of the fertilisation of the wife by the husband and there is no doubt that a child conceived by a wife as a result of A.LD. is illegitimate. Counsel could see no distinction between the position of a child conceived following A.LD. and a child born of a woman in whom the ovary of a donor had been grafted."
might ...
are obtainable from the Medical Protection Society, 50, Hallam Street, London, W.1. 2. Copies are obtainable from the Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1.
1.
Copies
vague, demanding, and often disgusting, doubly incontiand indifferent or unaware of it-and we accept " these, to the eternal credit of our geriatric nurses ". But we regard such a mental condition as temporary, requiring investigation and treatment of its cause, and we expect it to disappear as the patient improves. The doctors at The Bar have, from long experience, become very perceptive about such cases. They may be suspicious of a report of a patient wandering, and say to us : " We know you don’t usually take such patients, but the signs seem to us to point to serious illness." On the other hand, we cannot cope with aggressive noisy perpetually restless patients, who rove around the ward or scream from their cot-beds, striking the nurses, and shouting abuse at everyone. This behaviour would be alarming in any ward, but it is especially so to rational elderly people. Moreover, it is particularly disruptive to the routine of a geriatric unit, where the treatment ranges from blood-transfusions and drips for the very ill, to active rehabilitation with wheel-chairs, Zimmers, and Warrals for the convalescent. Again and again we have seen a problem patient, who has baffled us, quite transformed by a spell in a mental hospital-the mind soothed and restored to sanity by its atmosphere of calm, leisure, space, and freedom. And as for the acute mental patients to whom we refuse admission, surely the place for them is in the hands of the experts who have now so much to offer at all ages. The figure of 18% " not admitted " in the list of 1000 patients specially selected as most urgent, whom I visited from 1953 to 1961, remains much the same; for the year 1960 it was 17%. The proportion, which is not negligible, proves the continued need for our time-consuming task of "vetting the waiting-list ". A closer link with the general practitioners would no doubt help us to assess priority; but we should need more space and staff to deal with the constant telephone calls. Besides, the centralised system at The Bar carries with it the advantage of the right of appeal to other sources of accommodation when we are eager to admit but have no more beds. nent
I wish to thank Dr. W. F. Anderson for his constant encouragement ; the general practitioners who let us visit their patients; Dr. David Agnew and Dr. W. T. Rankin at The Bar; and the nursing staff of the geriatric unit at Stobhill, who have cheerfully and devotedly nursed so many of Glasgow’s elderly.
THE DEFENCE SOCIETIES Both English defence societies have the previous year’s activities.
lately reported
on
MEDICAL PROTECTION SOCIETY
At the society’s annual general meeting on Oct. 3, Dr. F. HARwooD STEVENSON, chairman of the council, spoke of instructions or rules issued by hospital authorities for junior medical staff: "When these deal with clinical matters over-simplification may be dangerous, and we have on one or two occasions found it necessary to undertake negotiations with hospital authorities to prevent unwitting interference with clinical judgment which might have resulted in danger to patients and consequent allegations against either the hospital or a doctor or
both." A further matter that gave trouble from time to time was the ease with which anterior teeth or crowns of teeth might be dislodged by some apparatus during anaesthesia. The old problem of suitable sites for injections continued to give trouble: It has to be remembered that "
there are very few suitable places, and the is not one of them." Harwood Stevenson suggested that sometimes Dr. in radiologists, making a negative report on an X-ray film, might usefully suggest either that further views be taken or that further films be taken later, if their experience led them to believe that such further investigation would be helpful. The cases described in the society’s annual reporti include one where an allegation of negligence in failing to diagnose fracture of the skull and intrathoracic injury was successfully resisted. in the
arm
triceps region
A shipyard worker, injured by a fall, was casualty officer who found several injuries
examined by a but no clinical intrathoracic injury. The
evidence of either intracranial or patient was sent home; and the following day an orthopaedic surgeon confirmed the casualty officer’s findings, applied treatment, and again sent the patient home. Next morning the patient died; and necropsy revealed a fractured base of skull with subsarachnoid haemorrhage, and fractures of the 5th-8th ribs on the left side with complete collapse of the left lung, the lower lobe having a small superficial laceration. The deceased man’s relatives brought an action for damages against the hospital alleging negligence by the hospital doctors in failing to diagnose the fractured skull and the intrathoracic damage, and in failing to admit the patient to hospital for observation. In the Court of Session judgment was delivered in favour of the defenders. The judge found that neither the subarachnoid bleeding nor the pneumothorax had manifested itself while the patient was at the hospital; and that " the evidence does not establish any practice of automatically detaining a man who has suffered a head injury (without losing consciousness) or a rib injury. Apart from practice reliance can only be placed on signs apparent at the time of the examination. It is not enough in order to establish negligence to show that other medical men would on those signs have acted differently." MEDICAL DEFENCE UNION
The annual report of the Medical Defence Union2 refers to the importance of case-notes : of the greatest value, not only when to another practitioner, but also in meeting any criticism that may arise. In many cases with which the Medical Defence Union is concerned, the notes are woefully inadequate. Those who teach students, housemen and assistants would render a great service to their profession if they would insist on proper note taking during and subsequent to their training. If a patient refuses to accept the advice of his practitioner it is most important that this fact should be recorded."
"... Good
handing
notes are
over a
patient
Among other subjects, the report discusses the question posed by a gynaecologist who proposed to attempt to graft a healthy ovary into the body of a young woman who had had both ovaries removed. "
If the operation was successful the patient after marriage become pregnant and the question was whether a child born of such pregnancy would be legitimate or illegitimate. Counsel’s opinion was obtained and he advised that the child would be illegitimate. A legitimate child is one conceived during wedlock by means of the fertilisation of the wife by the husband and there is no doubt that a child conceived by a wife as a result of A.LD. is illegitimate. Counsel could see no distinction between the position of a child conceived following A.LD. and a child born of a woman in whom the ovary of a donor had been grafted."
might ...
are obtainable from the Medical Protection Society, 50, Hallam Street, London, W.1. 2. Copies are obtainable from the Medical Defence Union, Tavistock House South, Tavistock Square, London, W.C.1.
1.
Copies