Friday, July 27, 2018

Evidenced based outcomes and medical negligence

Looking back on the twentieth century there is much evidence of major political and social changes geared towards improving the rights of ordinary citizens. Often viewed by contemporaries as an encumbrance these changes need to be seen in retrospect to understand their significance to human beings. Evidence based medicine is one such social control. Conceived as a benchmark of medical practice, evidence based medicine protects patients from medical excesses and follies whilst at the same time keeps practitioner's focus well and truly on the application of best practice in their professional endeavors. Now, in truth this does not make us any "weller or iller" but it does make us as consumers of the health service better informed. Evidence based medicine is not new and in twelth century Sicily they took treatment outcomes very seriously indeed.

Under the reign of Ruggero II of Sicilywhen a doctor was shown to be negligent in the care of their patient they were imprisoned and their material possessions confiscated by the state.

One hundred years later, Federico II of Sicily and Emperor of Germany, passed a law that all doctors required to financially compensate their patients where needless harm had been caused. Small consolation for Jean d'Arnand, physician to Pope Giovanni XXII who was condemned to the stake for not curing the pontiff. The fate of Giovanni di Boemie was not much better when he failed to cure the Pope's cataract. He was bound and gagged then placed in a sack and left to drown in a river.

King Carlo VI of France suffered a nervous disorder which he got little relief from his doctors. Two medical monks were decapitated when their therapy of crushed pearls, failed. No one is sure which caused the greatest offence to the King, the failure of the treatment or the actual cost. On the lighter side being a healer of the sick presents many challenges and no more so then when caring for the rich and powerful.

The health of Henry VIII has long been the topic of debate. Thought by many to have suffered gout, it is more than likely he died in the tertiary stage of syphilis. Recent studies however have inferred his demise may have been hastened as a result of a lack of Vitamin C. A committed carnivore with an almost exclusive diet of red meat he became distressed in later years with haemorrhaging. It was reputed his halitosis was so severe; few if any of his doctors could attend to him in the end.

Whilst doctors may risk everything they are historically well paid. Back in thirteenth century it was common place for an out of town physicians to negotiate, as part of thier fee, escorts both to and from the dwellings of their clients. Travelling was a risky business then, and especially when laden with ducats on the return journey. Medical errors sadly do arise and for that it is very important to protect consumers at all costs.

In France recently, a 51 year old man was prepped ready to have operations on his bunions, the orderly took him to the adjoining theatre by mistake and the chap woke up with a six inch penal extension instead of bunion less feet. Embarrassed to the extreme the hospital authorities were relieved to discover the man was delighted with his operation and had completely forgotten about his painful feet.


No comments: