Medical Politics – Why Bother? Richard FitzGerald Royal - MIR-Online

Medical Politics – Why Bother?Richard FitzGeraldRoyal Wolverhampton Hospitals NHS Trust

Politics“the process by which groups of people make decisions”Wikipedia

“Research has shown that teamwork training may reducetechnical errors by 30-50%”P.63 House of Commons Health Committee Report on Patient SafetyJuly 2009

“Lack of non-technical skills can have lethal consequencesfor patients. However the NHS lags unacceptably behindother safety-critical industries, such as aviation,in this respect”.P.98 House of Commons Health Committee Report on Patient SafetyJuly 2009

“Training in Human Factors skills such as teamwork andcommunication is virtually absent in healthcare”P.63 House of Commons Health Committee Report on Patient SafetyJuly 2009

“It should be mandated by regulation, taught and examined”P.63 House of Commons Health Committee Report on Patient SafetyJuly 2009

“The appropriate professional bodies should be activepartners in examining and assessing competencies in nontechnicalskills and Human Factors for both trainees andqualified staff”P.63 House of Commons Health Committee Report on Patient SafetyJuly 2009

Why Planes Crash: Lessons for RadiologyR B Gunderman, M D Cohen, J Am Coll Radiol 2009; 6:518-519

• Communication• TeamworkingR B Gunderman, M D Cohen, J Am Coll Radiol 2009; 6:518-519

“Like the airline industry ….. The most important factorsunderlying errors are typically not technological but human”R B Gunderman, M D Cohen, J Am Coll Radiol 2009; 6:518-519

Teamworking

GroupCliqueTeam

• “Practicising alone together”N. Edwards BMJ 2002;324:835

Politics“the process by which groups of people make decisions”Wikipedia

“With little or no cash increase from 2011/12the NHS will need to plan forreal terms funding to fall by 2.5-3% per annum”The NHS Confederation. Dealing with the downturn June 2009

“German doctors’ leader calls for debate on rationing services”Frankfurter Rundschau www.fr-online.de 8 May 2009BMJ 23 May 2009, Vol 338, p1234

• Public debate on rationing of healthcare• Which tests and treatments should be paid for bypatients themselves.• Cholesterol lowering drugs, “luxury medicine”Jörg-Dietrich Hoppe, President Bundesärztekammer

Individual clinical excellence is not enough ….• Standardised protocols• Care pathways• Process optimisation

Politics“the process by which groups of people make decisions”Wikipedia

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EBay style online auctions of teleradiology reporting

“Cuts costs one bid at a time”“Get the best price”

“If you meet the qualifications and provide the lowest bid, weaward the contract to you”

“auction’s free market system”“Bid it out, save a bundle”

Editorial: The impact of teleradiology in the United Statesover the last decade: driving consolidation andcommoditisation of radiologists and radiology services.G. W. L. Boland. Clin Rad (2009); 64, 457-460

Commentary: R FitzGerald. Clin Rad (2009); 64: 461-462

“The radiologist may be tempted to read two or three moreCT examinations rather than track down a referringphysician to ask for more pertinent clinical information”.G. W. L. Boland. Clin Rad (2009); 64: 457-460

“the market model requires that the contract be awarded tothe lowest bidder, who will likely have to work faster andfaster to make up for the fact that they are earning less perstudy than anyone else”.G. W. L. Boland. Clin Rad (2009); 64: 457-460

• Medical regulation in the telemedicine era.R FitzGerald. Lancet (2008); 372: 1795-6• Regulation and Revalidation of Teleradiologists.R FitzGerald. RCR Newsletter (2006); 87: 17-18• Revalidation: Radiologists, Radiographers, Clinicians andTeleradiology.R FitzGerald. RCR Newsletter (2005); 81: 15-17

EU Directive on the application of patients’ rights in crossborderhealthcare

Disadvantages of medical politics

• time, night, weekends• emails, attachments,• less time for family, self• no instant fix unlike a report

• “never there”• jealousy• less time for clinical reading• stress, apathy, disappointments

Advantages of “getting involved”

• shape destiny, not a victim• insights into humanity, oneself, colleagues• advance warning e.g. revalidation• improved negotiating skills e.g. job planning

• new friends• reduce risk of burnout• CEAs• legacy

Preparing for consultant interviews in clinical radiologyN Tahir et al. Clin Rad 2009; 64: 463-7

Politics“the process by which groups of people make decisions”Wikipedia

“Never has there been a bigger mistake than to do nothingbecause one felt one could do so little”Edmund Burke MP (1729-1797)

Evil flourishes when good people fail to act

Better to light a candle than curse the darkness

Shape your future …….. or else