Informing patients: The Bolam legacy

In the context of medical advice to patients, the UK decision in Montgomery v. Lanarkshire Health Board rejected the application of Bolam v. Friern Hospital Management Committee. This article argues that the rejection is neither complete nor settled. We explore doctrinal, conceptual and practical limitations of Montgomery to demonstrate the vestiges of Bolam’s relevance to medical advice. Medical advice does not end with disclosure of material risk but incorporates information on prognosis, diagnosis and treatment alternatives. Montgomery does not always apply in these cases, nor outside the medical mainstream or where patients lack capacity to consent. We identify ways in which the extension of patient-centred care in the giving of medical advice can be achieved through incremental development of Montgomery and application of the Bolitho gloss to require that processes conform to Montgomery principles of partnership and autonomy.

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The cost of consent: why healthcare providers must be compliant with the Montgomery principles

The Bone & Joint Journal ◽

10.1302/0301-620x.102b5.bjj-2019-1759 ◽

2020 ◽

Vol 102-B (5) ◽

pp. 550-555

Author(s):

Nick Birch ◽

Nick V. Todd

Keyword(s):

Positive Impact ◽

Healthcare Providers ◽

International Comparisons ◽

Point Of View ◽

Public Healthcare ◽

Health Board ◽

Malpractice Claim ◽

The Usa ◽

The Uk ◽

The Cost

The cost of clinical negligence in the UK has continued to rise despite no increase in claims numbers from 2016 to 2019. In the US, medical malpractice claim rates have fallen each year since 2001 and the payout rate has stabilized. In Germany, malpractice claim rates for spinal surgery fell yearly from 2012 to 2017, despite the number of spinal operations increasing. In Australia, public healthcare claim rates were largely static from 2008 to 2013, but private claims rose marginally. The cost of claims rose during the period. UK and Australian trends are therefore out of alignment with other international comparisons. Many of the claims in orthopaedics occur as a result of “failure to warn”, i.e. lack of adequately documented and appropriate consent. The UK and USA have similar rates (26% and 24% respectively), but in Germany the rate is 14% and in Australia only 2%. This paper considers the drivers for the increased cost of clinical negligence claims in the UK compared to the USA, Germany and Australia, from a spinal and orthopaedic point of view, with a focus on “failure to warn” and lack of compliance with the principles established in February 2015 in the Supreme Court in the case of Montgomery v Lanarkshire Health Board. The article provides a description of the prevailing medicolegal situation in the UK and also calculates, from publicly available data, the cost to the public purse of the failure to comply with the principles established. It shows that compliance with the Montgomery principles would have an immediate and lasting positive impact on the sums paid by NHS Resolution to settle negligence cases in a way that has already been established in the USA. Cite this article: Bone Joint J 2020;102-B(5):550–555.

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Aligning IT/IS with Business Strategy Re-Visited

Business Strategy and Applications in Enterprise IT Governance ◽

10.4018/978-1-4666-1779-7.ch009 ◽

2012 ◽

pp. 145-163 ◽

Cited By ~ 1

Author(s):

Kevin Grant ◽

Ray Hackney ◽

David Edgar

Keyword(s):

Complex Adaptive Systems ◽

Business Strategy ◽

Adaptive Systems ◽

Case Analysis ◽

Health Board ◽

Important Distinction ◽

Strategy Alignment ◽

Complex Adaptive ◽

Strategic Goals ◽

The Uk

This paper explores the co-relational process activities of information technology and systems (IT/IS) and business strategy alignment. The notion of “process” as being strategy and strategic alignment has been observed but not examined. Organizations are both complex and adaptive, and these attributes create significant challenges for managers when assessing strategic requirements. A need exists to further understand alignment as a process and embrace this concept when aligning business IT/IS with the strategic goals of the organisation. This highlights an important distinction of “process” that recasts the nature of congruence and reassesses the appropriateness and usefulness of current practice. The authors propose the use of principles underpinning complex adaptive systems as a way to re-orientate IT/IS alignment in a meaningful and more appropriate manner. The context for the study is the UK Health Service, and informed by a case analysis of 26 senior members from a Scottish Health Board.

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Bolam v Friern Hospital Management Committee [1957] 1 WLR 582

10.1093/he/9780191926396.003.0023 ◽

2021 ◽

Author(s):

Craig Purshouse

Keyword(s):

Hospital Management ◽

Tort Law ◽

Management Committee

Essential Cases: Tort Law provides a bridge between course textbooks and key case judgments. This case document summarizes the facts and decision in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. The document also included supporting commentary from author Craig Purshouse.

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Bolam v Friern Hospital Management Committee [1957] 1 WLR 582

Essential Cases: Tort Law ◽

10.1093/he/9780191897641.003.0023 ◽

2020 ◽

Author(s):

Craig Purshouse

Keyword(s):

Hospital Management ◽

Tort Law ◽

Management Committee

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Multispecialty tracheostomy experience

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0184 ◽

2020 ◽

Vol 102 (5) ◽

pp. 343-347 ◽

Cited By ~ 3

Author(s):

G Lipton ◽

M Stewart ◽

R McDermid ◽

R Docking ◽

C Urquhart ◽

...

Keyword(s):

Critical Care ◽

Case Series ◽

Neck Surgery ◽

Health Board ◽

Percutaneous Procedures ◽

Retrospective Audit ◽

Large Head ◽

Significant Case ◽

The Mean ◽

The Uk

Introduction Tracheostomy is a common surgical procedure used to create a secure airway in patients, now performed by a variety of specialties, with a notable rise in critical care environments. It is unclear whether this rise is seen in units with large head and neck surgery departments, and how practice in such units compares with the rest of the UK. Methods A three-year retrospective audit was carried out between anaesthetic, surgical and critical care departments. All tracheostomy procedures were recorded anonymously. Results A total of 523 tracheostomies were performed, 66% of which were in men. The mean patient age was 60 years. The majority (83%) were elective, performed for various indications, while the remaining 17% were emergency tracheostomies performed for pending airway obstruction. A fifth of the tracheostomies were percutaneous procedures. Most emergency tracheostomies (78%) were performed by otolaryngology. Three cricothyroidotomies were performed within critical care and theatres. Complications related to tracheostomy occurred in 47 cases (9%), most commonly lower respiratory tract infection. The mean time to decannulation was 12.8 days. Conclusions This paper discusses the findings of a comprehensive, multispecialty audit of tracheostomy experience in a large health board, with over 150 tracheostomies performed annually. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies. Around a quarter of those requiring tracheostomy ultimately died, mostly as a result of advanced cancer.

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Just say N2O – nitrous oxide misuse: essential information for psychiatrists

BJPsych Advances ◽

10.1192/bja.2019.57 ◽

2019 ◽

Vol 26 (2) ◽

pp. 72-81

Author(s):

Rollo J. G. Sheldon ◽

Michael Reid ◽

Frederick Schon ◽

Norman A. Poole

Keyword(s):

Nitrous Oxide ◽

Cognitive Impairment ◽

Mechanism Of Action ◽

Psychiatric Symptoms ◽

Diagnosis And Treatment ◽

Vitamin B ◽

Essential Information ◽

Principles Of Treatment ◽

The Uk

SUMMARYNitrous oxide (N2O) misuse is widespread in the UK. Although it is well-known that it can cause devastating myeloneuropathy, psychiatric presentations are poorly described. There is little understanding of who it affects, how it presents, its mechanism of action and principles of treatment. We begin this article with a case study. We then review the literature to help psychiatrists understand this area and deal with this increasing problem, and make diagnosis and treatment recommendations. We describe a diagnostic pentad of weakness, numbness, paraesthesia, psychosis and cognitive impairment to alert clinicians to the need to urgently treat these patients. Nitrous oxide misuse is a pending neuropsychiatric emergency requiring urgent treatment with vitamin B12 to prevent potentially irreversible neurological and psychiatric symptoms.

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The use of perineal pad testing to assess urinary incontinence

Reviews in Clinical Gerontology ◽

10.1017/s0959259897000099 ◽

1997 ◽

Vol 7 (1) ◽

pp. 83-92 ◽

Cited By ~ 3

Author(s):

SM Jeyaseelan ◽

JA Oldham ◽

BH Roe

Keyword(s):

Urinary Tract Infection ◽

Urinary Incontinence ◽

Urinary Tract ◽

Tract Infection ◽

Pelvic Floor ◽

Medical Advice ◽

The Uk

Urinary incontinence is a condition in which involuntary loss of urine is objectively demonstrated and results in a social or hygienic problem. A poll conducted for the Association for Continence Advice estimated that up to three million people in the UK suffer from incontinence. The incontinence may be transient, e.g. as a result of a urinary tract infection, or permanent, e.g. as a result of damage to the pelvic floor. Many sufferers may not seek medical advice for their predicament and the figures given above may be a gross underestimation of the problem.

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Differentiation of sero-fermentative types inBacterium coliO Group 55

Journal of Hygiene ◽

10.1017/s0022172400015473 ◽

1953 ◽

Vol 51 (1) ◽

pp. 39-48 ◽

Cited By ~ 12

Author(s):

Joyce Wright ◽

Regina Villanueva

Keyword(s):

General Hospital ◽

Hospital Management ◽

Management Committee ◽

Laboratory Staff

Biochemical and serological investigations were made uponBact. coliO 55 B 5 strains isolated from infants with diarrhoea and vomiting. On the basis of their reactions with six fermentable substances and of their H antigen types, the strains could be differentiated into three sero-fermentative types, I, II and III, which comprised, respectively, those having H6, H2 and H7 antigens.We wish to acknowledge our thanks and indebtedness to the following: the Chairman and Members of the Tottenham Group Hospital Management Committee, and Dr T. H. C. Benians, Dr W. I. Leslie and Dr R. Swyer, for facilities for research in the laboratory and wards of St Ann's General Hospital; Mr L. G. C. Maslen for most valuable advice and assistance; the entire laboratory staff for their willing and efficient help.

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