Last week’s unfortunate brain-surgery patient mix-up at the Kenyatta National Hospital raised an outcry from various quarters. Doctors bore the brunt of jokes on our apparent ineptitude and callousness — quite unfairly given the dedication most put. The public reaction does not take cognisance of the work environment health workers, especially those in public hospitals operate in.
For such cases, hospital administrators and the doctors’ union are at fault for compromising patient safety. With the advance of health systems’ quality monitoring, evidence indicates that omission and commission errors arising from overworking are responsible for some morbidity and mortality.
Elsewhere recently, doctors working past the eight-hour shift while overseeing too many patients got sued for negligence or malpractice after errors arose, highlighting legal pitfalls we face.
The traditional eight-hour day was set to ensure a good mix of work, rest and leisure. It has also been given that the ideal maximum patients a doctor can see in a day is 25 if each consultation lasts 15 minutes. This allows for breaks in between to pause, eat and refresh while offering adequate time to consult with the patient.
In most public hospitals due to long queues, consultations may be quite brief. Patients may leave such visits feeling their illness is demeaned. For inpatients, doctor contact time maybe even less.
What needs to be taken from the incident before it disappears from the public limelight, is the urgent need to implement professional work policies in our hospitals. Beginning with hours, staffing ratios, matching skill sets with interventions and importantly supervision by seniors. A raft of regulations must be put in place including penalising institutions and doctors who flout them.
Unfortunately, achieving ideal staffing ratios in public hospitals has been elusive due to heavy moonlighting in our profession. A past study by the World Bank noted that as much as 50 per cent of Kenyan doctors were not at their workstations daily for the required hours for one reason or another.
The doctors’ union has unfortunately not delivered on improving on work ethics. As a result, already understaffed hospitals are further compromised in meeting desired targets. While such situations went on in the past, it is unlikely to continue. Both the public and legal fraternities are now perturbed and a litany of suits are likely to follow because we have failed to self-regulate.
At the individual doctor’s level, well-intentioned decisions towards the patient’s care if against the work guidelines still renders one culpable. When the trials begin, the institution and the doctor each stand on their own.
Doctors have a role to play towards addressing professional workplace shortcomings not because mistakes are ultimately ‘individual’ regardless of their root causes, but for our patient’s ultimate benefit. For this to happen, we must start implementing hospital human resource guidelines.