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Doing it the hard way


Starting out in medicine is challenging enough without the problem of faulty equipment, deteriorating facilities and disaffected staff. Intern Dr Magnus Potgieter offers some advice on how to survive poor working conditions


L


ife as a junior doctor is challenging: the long hours in a stressful


environment can and does drive doctors to tears and insanity, a problem that is unfortunately compounded by poor working conditions in most South African state hospitals. Problems range from the marked deterioration in the physical structure of the hospitals to a lack of basic equipment and disaffected support staff. From the input of interns


and medical officers in the various provinces, this seems to be a national trend and is not limited to a specific province or hospital. We commonly experience


problems with the maintenance and hygiene of our working environment. It is important that problems are reported, usually to the sister in charge; it is very easy to become part of a culture of complaining but not doing anything about the problem. If you cannot solve the problem, report to the head of your unit or department. Also, you might have to report and re-report on several occasions and to several people: perseverance will solve the problem. Equipment problems


can range from the most basic supplies to expensive equipment, such as blood gas machines. It is important to insist on the correct equipment. I learned this the hard way after pricking myself with a short suture needle,


trying to handle it with my hands because they didn’t have handheld “Colt” needles available in the ward. It is not worth the risk! If you cannot find a handheld needle, then open a stitch pack and use instruments. It is not a waste of a stitch pack. It is, however, a waste if you prick yourself and demise later due to hepatitis C. You are under no legal obligation to risk your life for a patient, but keep the risks of your actions in mind when, for example, deciding not to put up a CVP for a patient because of a lack of the correct suture material. Reconsider the reason for and alternatives to the CVP. Remember that the test whether your actions are


room; it’s just that no-one has bothered to unpack it. If equipment is lacking, ask the sister to sign in the patient’s notes that it is truly unavailable, or at least that you discussed it with her. It is astonishing how things can sometimes suddenly be ordered from other wards once the sisters are informed that they can also be implicated in a medicolegal case, and that you need their name in case they need to call her to court. This principle would also


hold for nursing tasks. For example, if you are starting a blood transfusion, then write down the orders for regular vitals and patient condition, plus the date, time and which sister you personally


You are under no legal obligation to risk your life for a patient, but keep the risks of your actions in mind


justified always boils down to what the reasonable doctor would have done in your position. It may have been reasonable to personally check in the other wards for the suture material rather than to refuse to do the procedure. Also, for any equipment


related problems, explain the situation to the sister in charge. If she cannot or will not help you, call the matron on duty. Chances are there are many unopened boxes somewhere in a store


told about the transfusion. If you don’t target and assign responsibility to a specific person, the task is likely to not be carried out, and if complications arise, no-one will take responsibility – which might ultimately have to be taken by the doctor who gave the orders, unless it was documented as above. You may also need to


explain the lack of proper equipment to the patient. If it will impact your management or increase the risk to the


patient, explain this and ask them to sign informed consent before you embark upon the procedure. For example, the lack of an ophthalmoscope to examine a patient for raised intracranial pressure before a lumbar puncture may be a contraindication to the procedure, but if a complication should arise, the test would be what a reasonable doctor would have done in the circumstances with the resources available at the time. Did the benefit outweigh the risk? It would certainly improve your case if you explained the increased risk to the patient and he signed that he is willing to undergo the procedure. Consider that they might assume that a reasonable doctor would have asked for senior advice, have enquired about scopes elsewhere in the hospital, and reconsidered if the procedure was really indicated and so forth.


Faulty equipment and the Consumer Protection Act I still remember the first time we had to defibrillate a patient in the resus area. It was wonderfully exciting, having only witnessed the event on ER and House before. The registrar did everything by the book/TV and even yelled “Clear!” next to me so hard I nearly had an arrhythmia myself – only to find that the defibrillator was not working. In addition, in the last two months we had two


ARTICLE


JUNIOR DOCTOR | VOLUME 2 | ISSUE 1 | 2011 | SOUTH AFRICA www.medicalprotection.org


SEAN_WARREN/ISTOCKPHOTO.COM


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