An interesting idea Katherine but I foresee problems. Complaints are rather
idiosyncratic; as most of you know the majority of complaints are wholly
unjustified and should properly be described as mischievous...they certainly
are in my neck of the woods. Litigation is similar, the litigation rate will
depend more on the litigiousness of your punters, which is very high in
London NW3, for example, but pleasantly low in London E1, I expect! Most
clinical negligence claims are unsuccessful in the end, and lawyers are not
very interested in death - it doesn't pay as well as disability, unless the
deceased was the breadwinner and there are surviving dependants.

But as someone earlier wrote, there must be some way to compare existing
departments which have differing levels of senior cover, or to use
historical controls. It will be well nigh impossible to set up a true RCT
for ethical reasons, and therein lies the rub; surely most intelligent
commentators agree that seniors make a difference to outcome in acute
medical emergencies?

And finally, I think ML is specifically looking at consultant involvement
rather than leadership. Involvement may mean a glance at the patient and
discussion with the SHO but that alone makes a difference (there's no
benefit in consultants doing the bloods, but there is surely benefit in
consultants making the "big" decisions). The government already accepts that
consultant lead departments are a good thing, but it only takes one or two
consultants to lead a department. By contrast a consultant based service
means some consultant input into the majority of cases, and input into all
seriously ill cases. Whether that has been proven to make a difference is
the question Mike is asking I think.

Adrian Fogarty


----- Original Message -----From: Katherine Henderson
<[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, October 28, 2000 9:04 PM
Subject: Re: seniority of doctors


> I am also interested in this area but from the risk management
perspective.
> Currently I am doing the UCL Risk management MSc and am just starting my
> second year. I have to do a dissertation and have been reading around for
> topics. One of the big questions seemed to me, the risk management
> implications of having seniors in the department but I could not think of
> any way of doing the research well. I considered that it might be possible
> to get some interesting information about complaint and litigation rates
but
> felt it unlikely that departments would be willing or able to give out
that
> information. The well resourced departments might but smaller ones might
be
> reluctant. However a low litigation/ complaint rate would be a powerful
> argument for having seniors.
>
>
> Any thoughts?
>
>
> Dr Katherine Henderson
> Consultant in A&E Homerton and Royal London Hospital




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