Why the hospital will kill you before a plane crash does

“The number of adverse events each year (is) equivalent to 13 jumbo jets crashing and killing all 350 passengers on board,’’ Rudd’s National Health and Hospital Reform Commission says in its recent report on the health system.

Well, that got my attention. If that many 747s were crashing I’d never fly again. Would I be better just avoiding the doctor, and the possibility of hospital altogether? 

One man who has some firm and long-held views about ways to reduce the number of preventable mistakes is Guy Maddern, Professor of Surgery at The University of Adelaide and author of the handy little book “Questions You Should Ask Your Surgeon”, first published in the mid 1990s.

Maddern says there are millions of procedures in hospitals, so the amount of mistakes is pretty small. And the 13 jumbos weren’t full of surgical mistake victims. All sorts of things can go wrong in hospital – for example, the wrong dose of medicine, the completely wrong medicine, or maybe no medicine at all.

But surgical errors happen, and not all surgery is appropriate in the first place. Maddern says that in the same way that we don’t just take our new car to just any mechanic, we need to take a more questioning approach to the health system, and look at the experience of the people we allow to operate on us.

“The book is a few years old but I don’t think anything’s changed to be perfectly honest,” he says. As for the most important questions, he says we should focus on “establishing the surgeon’s experience in the procedure undertaken, if there’s something they practice on a regular basis.”

The other issue is to ask about the alternatives that might also work. “We are surgeons, so we tend to see most solutions as a surgical solution and there are other options and most surgeons are aware of them,” Maddern says.

“Physiotherapy in some cases can be as successful in outcome as surgical interventions, so it’s very useful for the patient to ask what the options are. The surgery might give you a 70 per cent chance and the non surgical 40 per cent, but you might want to go that way first.”

Change is slowly coming, and he points to a new surgical checklist approved by the World Health Organization. It’s about to be launched in Australia this month as a national standard, and involves the surgical team just doing a few simple checks at critical times of the operation.

The fact it didn’t exist before is amazing, and the results it has produced are impressive.

After a trial in hospitals in eight cities worldwide, the results showed that patients who suffered major complications after surgery dropped from 11 per cent before the use of the simple checklist to seven per cent – a one third reduction.

It deaths, it was even greater, falling from 1.5 per cent to 0.8 per cent – a 40 per cent drop.

“The concept of using a brief but comprehensive checklist is surprisingly new to us in surgery,” noted Dr Atul Gawande, the main author of the study. “Not everyone in the operating teams were happy to try it.”

But the 19-point list used before anaesthesia, incision and then before the patient left the operating room, was very successful.

Maddern says it makes sense to double check “so you don’t accidentally operate on the wrong patient, or accidentally overlook an allergy - that of course is only going to happen once in your practising life but for the individual patient it’s a complete disaster.”

In fact, what doctors are moving towards is exactly what pilots are already doing prior to take-off. “It’s absolutely what pilots do,” he says. “And what we’re trying to do is roll it into an environment where that’s not been part of the culture.”

Given the analogy about crashing jumbos, the more we can make doctors like pilots, the better we will all be.