Liberation for Egypt

Friday 11th February was a momentous day in Egypt's history when, after 18 days of protest, President Hosni Mubarak stepped down from power after 30 years of rule over the country. The announcement was met with dramatic scenes of jubilation and celebration in Cairo, concentrated around Tahir square. I am relieved that my parents left Egypt having been living there for four years, before the riots began. During the protests, the reports sounded like the city of Cairo which I know fairly well had become dangerous and chaotic. After all of the destruction (and many dead/injured of which I am 100% sure the Egyptian authorities are under-reporting numbers), I hope that the country will become stable and improved in future. I think that the next 12 months will be a very difficult time for Egypt as it tries to recover from the events of the past few weeks but I hope that the people see the benefits in the near future.

The theme of this month in uni is very much on how to improve patient safety in healthcare. I'm working with two other students on a project on improving venous-thromboembolism patients in hospitalised patients. We have found that there is a significant amount of evidence to show that prescribing mechanical or chemo-prophylaxis can improve patient outcomes to prevent deep vein thrombosis or pulmonary embolism. Worryingly though we have also found evidence from a worldwide study to show that prophylaxis is commonly either underprescribed or poorly prescribed. What we want to do is to find out if this is the case in Ninewells Hospital and if so, what can we do about it.

Continuing with the theme of patient safety, there are two articles in the BMJ this month on the same subject. The first: Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluation, Benning et al, asks what the impact of this intervention was from the Institute of Health Improvement (IHI). The answer was that the quality of monitoring sick patients on medical wards participating in the project was better than hospitals not taking part. The study shows that quality improvement interventions tackling specific issues such as hospital acquired infection are easier to demonstrate change that massive systemic change in large organisations. The next article: Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase, Benning et al, asks whether the NHS has become safer as a result of the Safer Patients Initiative. They found that while the NHS in England has become safer, hospitals taking part in the initiative were not necessarily safer than those not taking part.

Finally, there was a very interesting article in the BMJ News this week in the "See One, Do One - Working and Surviving as a Junior Doctor" section, written by Dr Freda McEwan, a CT1 trainee in psychiatry. She writes about an instance as a surgical FY1 when she had to break bad news to a patient. Despite evidence of a diagnosis of disseminated malignancy with metestases, she had not been told of the news. Despite the doctor's recommendations that the discussion with her be had with a more senior member of staff and not during the night (she had been asked to see the patient at 1am), the patient was terribly upset saying "why won't anyone tell me" and asking the doctor "do you know what is wrong?". Not wanting to lie, the doctor told the patient the diagnosis, and she was pleased because she said that "finally she would be able to plan for the future". I think that the doctor was correct not lie and was correct by telling the truth. However I do not know if she should have given the diagnosis that night, so late on. She ends the article by saying "as a junior doctor, you often feel that the public has higher expectations of you than you merit. But as any doctor, all you can ever do is your best."

Now on that note I can enjoy my Valentines Day tea which Amy is cooking for me tonight (lucky me!).