Malpractice litigations are robbing the state of funds set aside for ensuring a healthy life for all, writes Dr Tendani Matoro.
WITH the growing interest from lawyers and other stakeholders in the affairs of patient safety, or rather vested interest in profits from litigations, we find ourselves as doctors more stressed than ever before.
The revised “National Guideline for Patient Safety Incident Reporting and Learning in the Health Sector of South Africa” of April 2017 tries to reassure professionals in state hospitals to report unwanted, unexpected or undesired negative patient incidences.
The preamble statement by the National Director General of Health (in the guideline) acknowledges how medical malpractice litigations have skyrocketed in South Africa. This impact is fast robbing the state of funds initially set aside for “achieving a long and healthy life for all South Africans”.
How do we strike the balance of reporting “mistakes” in a setting where one’s head will be put on the block, chopped off and hung on a stick for all to see? In a world were Professional errors, at risk behaviour and reckless misconduct or negligent behaviour are all classified under causes of patient safety incidents (PSI), how can we ease the shame and pain of reporting an honest clinical mistake?
The Life Esidimeni hearings show the public an ugly side to the medical profession. Assault incidents of the elderly on social media or YouTube have also not done us any justice as healthcare workers. The ongoing beliefs and stories told of government clinics health professionals have become modern day horror stories keeping some sick people well away from seeking the much needed care. Can we blame our people for the loss of confidence and faith in healthcare facilities?
Developed vs Developing Countries
In most instances, there is no argument that developed countries are close to achieving the International Classification for Patient Safety. The reduction of risk of unnecessary harm associated with health care to an acceptable minimum is the international meaning of patient safety. Worldwide, it has been estimated than tens of millions of patients experience disabilities or death annually.
Harmful incidents result in harm to a patient that is related to medical management, in contrast to disease complications or underlying disease. These are also termed adverse events. Complications in children hospitalised in developing countries can be as high as 3-20 times compared to developed countries.
The estimated risk of permanent disability or death after an operation is developed countries is 0.4 – 0.8%. In our developing countries, expect risks as high as 5 – 10%.
It seems up to 70% of injections given in developing countries at clinic or hospital levels have been shown to be unnecessary. This means that some of these could have been replaced with oral medication which could have easily cured the ailments similarly. Are we succumbing to the pressure put on us by our patients of giving them injections against our clinical discretion?
Third World Problems
The World Health Organisation (WHO) has summarised these 10 problems that still cripple developing countries’ healthcare system leading to patient safety concerns:
- Health care associated infections (HAI)
- Preventable adverse drug events
- Adverse events in mother and/or baby related to prenatal, labour and postnatal care period.
- Adverse events due to surgical and anaesthetic care
- Adverse events related to wrong and/or late diagnosis
- Adverse events related to injection practices
- Adverse events related to unsafe use of blood and blood products
- Adverse events related to medical device use
- Patients falls and injuries due to falls
- Pressure ulcers
Health professionals have a responsibility to reduce and eliminate these problems, but cannot do so alone.
Patient and Relatives Centred Care
In South African public hospitals, guidelines, protocols and standard operating procedures (SOPs) have helped reduce patient complications significantly over the years. Our existing problems cannot simply be summed up by poor training of health professionals, misdiagnosis or acts of omission by health professionals. Some, if not most of the cases, are multifactorial. Workload pressures, poor health system accountability, organizational failures, stress and fatigue of healthcare workers are usually overlooked.
All patients and their relatives are invited to become a part of the solution to this complex process. Improved patient follow up after diagnostic or therapeutic tests still remains a huge responsibility of patients and relatives. Honouring one’s follow up date can reduce additional workload and unexpected outcomes.
Here are some pointers to patients and relatives to help curb the 10 domains in developing countries:
- Health care associated infections (HAI): Ensure that your healthcare professional washes their hands before and after touching you. Relatives are also encouraged to do so during visiting hours.
- Preventable adverse drug events: Be informed about your medication’s side effects before leaving the healthcare facility. Unexpected or undesirable effects otherwise not stated can still occur. These need to be reported to your healthcare providers immediately.
- Adverse events in mother and/ or baby related to prenatal, labour and postnatal care period: Know the pregnancy danger signs that need urgent hospital intervention. When in labour, be informed of your rights and responsibilities to facilitate a healthy delivery. After giving birth, know when to come back if you or your child has specified problems.
- Adverse events due to surgical and anaesthetic care: Have an idea of the kind of operation you are getting, including the sedation, muscle relaxation (if needed) and pain control (collectively called anaesthesia) as explained during your consent form signing. Ask about possible complications that may occur well before your procedure is done.
- Adverse events related to wrong and/or late diagnosis: If you think you are not getting better or improving on your current medication, insist on a second medical opinion to broaden the scope of your diagnosis. Kindly do so with your current treating professional’s awareness.
- Adverse events related to injection practices: Sometimes injections can be risky. Understand why you cannot get an antibiotic injection for flu or that not every doctor visit needs an injection.
- Adverse events related to unsafe use of blood and blood products: If your religion/belief allows for blood transfusion, let the healthcare professionals assist you with informed consent for blood transfusion. This will explain the risks and benefits of blood transfusion.
- Adverse events related to medical device use: Report any problems from any clinical machine or medical device used on you. This could be in or out of hospital.
- Patients falls and injuries due to falls: If one has been feeling weak or extremely tired before visiting hospital, insist on a walking aid or assistance when moving around the emergency unit or the ward. A simple trip to the toilet could be lead to a fall.
- Pressure ulcers: When caring for a bedridden relative at home, ask your local clinic about routine positional change in bed. Disclose any known pressure sores (any part of the body exposed to pressure) to healthcare professionals. If a relative has been admitted for a prolonged period of time or bedridden in hospital, enquire about pressure sores.
Dr Tendani Matoro is a Medical Doctor (MBChB, UCT), General Practitioner (Polokwane), Clinical Advisor (Advanced Clinical Care HIV/AIDS and TB), Social Commentator (News24 and WordPress Blog) and Medical Columnist (Weekly Publications in African Times Newspaper)