Hospital-At-Night (HAN) / Skin Camouflage

Costa Concordia lying just off the island of Giglio

Mortality Rates among Hospital Patients - A review of hospital care last year claimed to have found that higher death rates existed among hospital inpatients outside normal working when less consultants were available on call for advice. The press jumped on this, remarking that "junior doctors were often left in charge". To a large extent this is true. The hospital at night is staffed by less experienced doctors. Obviously we all have to be exposed to out-of-hours work in order to gain experience, but surely there should be someone more experienced on-site overnight. An article in the BMJ this week argues that the analysis of the data used to make these assertions was flawed however it remains true that at the weekends or at night patients in hospital are less safe. Out-of-hours there are always on-call, experienced consultants and experts available for advice however they are only available in emergencies. But if there were more experienced doctors on-site seeing patients before they deteriorated, could these situations be prevented? Or perhaps a more experienced doctor in A&E would be more to identify the one patient needing urgent attention, out of the ten or more who have illnesses which will be straightforward to treat. I don't think that there is an easy solution to this problem but one thing is clear to me - junior doctors need more senior support out-of-hours.

Port wine stain (eg. Sturge-Weber syndrome)

Dermatology - Skin Camouflage: An educational article in the BMJ this month. It opens with the reference that 15% of people seek help from their GP for a skin condition and most patients have their skin condition diagnosed and treated in primary care. In many cases, skin disfigurement can have serious long term psychological consequences. Various health related quality of life indices consistently show a link between severity of skin disfigurement and impact on quality of life. Skin camouflage can help patients adjust to an altered image and disguise an alternated appearance with good effect. Examples of conditions which respond well to skin camouflage include vitiligo, scarring from burns and port wine stains (see above). Skin camouflage services are not readily available in primary or secondary care and most access is private. However given the mounting evidence of the impact of skin disease on mental health perhaps there is good evidence for it being made more widely available. Or is skin camouflage just changing the skin appearance (symptom control) and not treating the underlying cause? Does this matter?