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Martha’s rule…
… the culmination of lobbying by clever, articulate parents who lost their precious child in desperate circumstances.
They knew, they knew their daughter better than any doctor knew their daughter.
Better than anyone. They tried but wherever they tried… they wouldn’t listen.
There is no making amends. Just a lifetime of remembering and if there is any comfort, knowing... now they’ve made us all listen.
Listen to the common sense that says there will be times were a second pair of eyes and second look, a second or two spent reflecting… asking a second person, is there something else, is time well spent
The General Medical Council, which regulates doctors says;
‘… all doctors must 'respect the patient's right to seek a second opinion'. A 'reasonable' request from a patient for a second opinion should not be refused.’
There is no legal right to a second opinion. Martha’s rule doesn’t change that.
Whilst a healthcare professional will rarely refuse to refer for a second opinion, there is still, no legal right and a request can be seen as doubting competence and can introduce friction at a time when friction is the last thing anyone wants.
What does Mather’s Rule change? It seems to me it has the potential to change very little.
Look how narrow it is.
‘Families will be able to request an urgent review from hospitals if they are worried about the condition of a loved one in critical care.’
Key words; ‘request’ and ‘critical care’.
‘One hundred hospitals with critical care units will be invited to sign up for the initiative, which will be rolled out from April.’
Key words; ‘invited’ and ‘one hundred’.
Martha's-rule means; critical care outreach teams, 24-7, can review patients if they get worse and that may trigger a second opinion from a consultant.
Critical Care Outreach Teams are already doing that.
CCOTs offer intensive care skills to patients with, or at risk of, critical illness receiving care in locations outside the intensive care unit… on wards or in some cases, the community.
They are the UK version of the USA, Rapid Response Teams (RRTs). In Australia, Medical Emergency Teams (METs).
CCOTs differ from RRTs and METs in that they are generally nurse-led, doctor supported, whereas the others are led by medical staff supported by nurses or technicians.
The University of Pittsburgh Medical Center Shadyside and Children’s Hospital appears to be the first facility in the U.S. to have invited patients and families to call for a RRT to address unresolved concerns about their safety and health.
CCOTs started here following the publication of Comprehensive Critical Care 2000, in response to evidence that ward-staff needed more support in their management of acutely deteriorating patients.
After 24 years, I don't think all hospitals have CCOTs.
In addition to that, there is NEWS2… a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adult patients, described as;
‘… a key element of patient safety and improving patient outcomes.’
All ambulance trusts and 76% of acute trusts are using NEWS2. Try to avoid the 24% who are doing something else.
How? Dunno…
PEWS, is the paediatric version.
So, what is the upshot of all this?
It heightens awareness of the dangers of groupthink and tunnel vision. It is founded upon what good hospitals are already doing and it tells me…
… this family were badly served by poor doctoring, that brings with it more than a whiff of arrogance that no amount of political gimmicks, rebadging, zombie-change and sympathy will resolve.
All the mechanisms of escalation were in place for Martha… they just weren’t used.
If doctors shy away from a second opinion they undermine the whole practice of medicine… which is based on sharing learning and opinions in the simple and humble pursuit of excellence.
The death of beautiful Martha has given us no change in the law, no real change to the systems that are already in place, no change in the professional arrogance that caused this tragedy and no change to bandwagon politics.
Trusts will be obliged to ask and record relative's view of the patient's progress.
Martha and every Martha, Marys, Michaels and millions of families deserve much more. The right to a second opinion, enshrined in law.
The announcement comes with posters and stickers… good, it raises awareness, notwithstanding it is alleged some loutish doctors tore them down... incomprehensible.
Maybe awareness is enough to embolden the public?
In Germany, patients have some legal rights to obtain a second medical opinion under the Patient Rights Act (Patientenrechtegesetz), 2013.
As for the NHS? To tell you the truth, without the force of law...
... I'm not optimistic.
Have the best weekend you can.
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