Patient safety & health care

Abstract

Dear Editor, Reference is made to two letters to editor pertaining to patient safety and health care [1, 2]. Following is offered as comments on the subject. Every doctor during his life time of practising medicine has to focus on a single theme. Shall we redefine this theme as “better attitude and care towards patients”? If accepted this theme cannot be achieved on fixed and rigid ideas. Rapidly changing medical science has direct bearing on the chosen theme and will keep it fluid requiring the “provider” to be always in “learning mode”. The present system of learning and updating by medical officers in Armed Forces is dominated by tradition and institution, which is not always justified. Unlike a bucket, the human mind does not fill up in a passive manner. Analysing further the present system at grass root level of health care is more “retrospective” rather than “prospective” based learning. Judicious use of evidence based practice of medicine is almost non existent except in some tertiary care hospitals. In the quest to remain focused on the chosen theme, alternate learning strategies in the form of group based and problem based learning techniques need to be adopted at all levels of Armed Forces Medical Services. Group based learning fosters critical thinking, improves and promotes clinical judgement. Participants learn from each other and their interaction adds to the richness and depth of learning experience. This learning strategy inculcates a sense of cooperation and has the potential to change the present culture of “name it, blame it, shame it”. Problem based learning is closely linked to evidence based practice. As active members of clinician group, we have attempted above alternate learning strategies in two hospitals i.e Command Hospital (Air Force) and No 5 Air Force Hospital. The initial fear, hesitation and sluggishness have given way to enthusiasm and active participation. We have reaped rich dividends as applicable to day to day clinical practice. Incorporating clinical audit meeting into these learning strategies has brought about more cohesiveness among peer groups, better referral system and above all true & effective team management. Scientific usage of antibiotics and thereby reducing nosocomial infection and precious funds has been the other benefits. These alternate learning strategies as applied to health care could easily be adopted at every level to bring about the desired level of patient safety. “We think too much about effective methods of teaching and not enough about effective methods of learning.” - John Carolous SJ.