My message below is in response to Dr Neil Pakenham-Walsh’s request for HIFA members to share their experiences relating to patient safety.
There is an old joke in which an engineer, an architect and a doctor are arguing about which profession is most common. The architect and engineer make their cases, citing population statistics, facts and figures. The doctor leans back and quietly states that he has been suffering from headaches lately. Immediately, the engineer suggests stress, the architect recommends painkillers, and another friend suggests an eye test. The doctor laughs: “You see? Everyone is a doctor!”
The serious aspect of the joke came to mind as I reflected on the experience (from some years ago) of a relative in a low-income country, where access to private healthcare was increasing among the middle classes.
After returning from a holiday, people commented that one of her eyes appeared smaller than the other. They encouraged her to consult one of the country's leading ophthalmologists, who found nothing obviously wrong but prescribed eye drops. When these made no difference, a relative who'd had Bell's palsy suggested she see another doctor. The doctor agreed it was Bell's palsy and prescribed steroids – but these made no difference.
Meanwhile, other relatives had noticed that she was walking differently and that her balance seemed poor. This was attributed to an old toe injury and ageing. She was eventually seen by a well-known orthopaedic surgeon, who performed a minor procedure on the toe. Her walking did not improve – in fact, it became worse. Her hearing impairment, which she had had since childhood, also seemed to be deteriorating; this too was attributed to age.
Eventually, a family member persuaded her to seek assessment overseas. There, she was diagnosed with a large acoustic neuroma (vestibular schwannoma). Although benign, it was sufficiently large and close to the brainstem to be potentially life-threatening. Most of the tumour was removed, but she has been left with lasting problems.
Looking back, I see two main patient-safety issues.
First, there was fragmentation. Different symptoms were considered separately, there was apparently no one putting them together, and when initial treatments did not help, there was not always effective follow-up or reassessment. Several symptoms were attributed to pre-existing problems or ageing rather than prompting a broader review. The eventual delay in diagnosis resulted in significant and lasting harm.
Second, there was the “everyone is a doctor” problem. Family members and other non-medical people were understandably trying to help, but were making medical suggestions that influenced the patient's decisions. This highlights another important aspect of patient safety: people need access to reliable, understandable health information so that they can recognise concerning symptoms, know when and how to seek appropriate care, and distinguish informed advice from plausible-sounding speculation.
Perhaps the lesson is that patient safety requires much more than just having more doctors available. It requires continuity within healthcare, a robust system through which disjointed health professionals can communicate, centralised records, effective follow-up, an understanding by patients of "trusted" sources and, of course, access to reliable health information.
Best wishes
Julie
HIFA profile: Julie N Reza is a UK-based specialist in communications for biosciences, global health & international development (www.globalbiomedia.co.uk). She predominantly works with NGOs and not-for-profit organisations. Previously she was the senior science editor at TDR, based at the World Health Organization (WHO) in Geneva; prior to this she worked at the Wellcome Trust, UK, leading educational projects on international health topics including trypanosomiasis and trachoma. She has a PhD in immunology and a specialist degree in science communication. She also has several years research and postgraduate teaching experience. She is a member of the HIFA Steering Group and HIFA Social Media Working Group. www.hifa.org/people/steering-group
www.hifa.org/people/social-media naimareza AT hotmail.com