ABSTRACT
The process by which senior hospital doctors are disciplined within the National Health Service is analysed. The mechanisms used are discussed and a number of faults are identified. Many of these faults give an unfair advantage to management and are contrary to the rules of 'Natural Justice'. These faults lead to an excessive number of doctors being wrongfully suspended for an unnecessarily long period. The process is oppressive to doctors as well as being contrary to the Human Rights Act. A number of risk factors are identified; race, sex, speciality and obstetricians appear to be particularly vulnerable. The process causes significant morbidity as well as having a 2% mortality. The process is also remarkably inefficient with management, despite all the in built advantages, unable to prove that the suspended doctor is at fault in the majority of cases. It is also very wasteful of the NHS's financial resources.
Subject(s)
Employee Discipline , Obstetrics , Professional Misconduct , Female , Hospital Administrators , Humans , Interprofessional Relations , Medical Staff, Hospital , Obstetrics/standards , Pregnancy , State Medicine , United KingdomSubject(s)
Attitude to Death , Christianity , Physician-Patient Relations , Religion and Medicine , Aged , Blood Transfusion , Hematemesis/surgery , Humans , Male , Terminal Care/standards , United KingdomSubject(s)
Blood Transfusion , Christianity , Jehovah's Witnesses , Treatment Refusal , Decision Making , Emergency Medical Services , Family , General Surgery , Humans , Paternalism , PhysiciansSubject(s)
Clinical Competence , Psychotherapy , England , Physician Impairment , Psychiatry , Societies, MedicalSubject(s)
Human Rights , State Medicine , Employee Discipline , Humans , United Kingdom , United NationsSubject(s)
Anesthesiology , Defensive Medicine , Legislation, Medical , Malpractice , Humans , United KingdomSubject(s)
Anesthesia, Obstetrical , Cardiac Output , Cesarean Section , Female , Humans , PregnancyABSTRACT
A clinical study of the use of intrathecal morphine in two groups of surgical patients, 32 in all, showed that the morphine provided very powerful and prolonged analgesia with little disturbance of cerebral function. When combined with a spinal block it did not interfere with the action of the spinal anaesthetic. When combined with a relaxant technique of anaesthesia some persistent curarisation was seen. The only complication to emerge from the study was respiratory depression which could be very delayed in its offset. The depression was sufficient to induce carbon dioxide narcosis in two patients. It is suggested that the dose of intrathecal morphine in the very elderly should be very severely restricted as they appeared to be unduly sensitive to the respiratory depressant effect of morphine when given intrathecally.
Subject(s)
Morphine/administration & dosage , Pain, Postoperative/prevention & control , Adult , Aged , Analgesia , Cholecystectomy , Female , Hip Prosthesis , Humans , Injections, Spinal , Male , Middle Aged , Morphine/adverse effects , Morphine/therapeutic use , Postoperative Complications , Respiratory Insufficiency/chemically induced , Time FactorsABSTRACT
Studies in patients undergoing peritoneal laparoscopy, in which carbon dioxide was used as insufflating gas, showed that artificial hyperventilation was an effective means of preventing serious hypercapnia. The hypercapnia caused a rapid hyperkalaemia and there was a linear relationship between the two. Reversal of the hypercapnia caused the serum potassium to fall towards normal but the speed of this fall did not match the speed of reduction in Paco2. It is suggested that the changes in serum potassium following changes in Paco2 may have some clinical relevance in potassium-depicted patients.
