Thanks to the many of you who contributed to the discussion by expressing your views and in particular thanks for the honesty of those views. You have articulated a broad range of valid views about the reasons in this story for different potential courses of action.
The doctor is clearly very busy and under pressure perhaps too. She has made some decisions at least partly based on a set of guidelines. Perhaps that is the best course of action, after all that is why the guidelines have been written and implemented. However perhaps she is also displaying that she is under pressure, a little stressed and that in forgetting to listen to the views that the patient was actually expressing, she jumped to apply them too quickly . Unfortunately it seems that her manner may have contributed to an undermining of trust and may have inhibited the establishment of a trusting Patient/Doctor relationship.
A majority of you felt the reason for the doctor taking the course of action she did is because she is too busy and distracted.
Remember what was said in the introductory Patient Safety Lecture; if you are Hungry, Angry, Late or Tired; HALT. One of you made the following points: as the “doctor is stressed” this is a “factor predisposing [to] the possibility of error; there is a clear relationship between stress and performance.”
Remember this graph:
The A&E (ED) is very busy – this is a situation with an increased risk of error occurring. Of course we should also remember that A&E is a place where teams work and perhaps if there was extreme pressure causing her to drop her standards of work, it would have made sense to stop and get the team together to plan a course of action together rather than making the decision alone. If there is range of expertise in the unit it would be prudent to avail of this and make the decision a joint decision based on consensus. Teams usually outperform individuals when they work well together.
It is interesting that in the second poll the opinion about applying guidelines (‘the rules’) for particular courses of action is so split. Perhaps subsequent episodes of Jane’s story will allow us to unpick some of these views.
Ultimately as doctors we strive to uphold the highest standards of safety and quality and over the next four episodes with reference to the GMC Publication ‘Good Medical Practice’ we will explore how we can develop and maintain these high standards.