Will The New British Government NHS Staffing Plan Work? I Don’t Think So! Part Three

In his book “Blackbox Thinking”, author Matthew Syed told the story of an incident in an operating theatre. A patient had an allergic reaction to the surgeon’s latex gloves. The anaesthetist informed the surgeon and recommended a change to non-latex gloves, but the surgeon refused. He relented only after the anaesthetist threatened to call the hospital administrator. After the change of gloves, the patient’s negative reaction ceased.

Syed told the story to highlight some of the causes of preventable medical errors. His point was: if the anaesthetist had not insisted the surgeon change his gloves, the patient would have died, and the cause of death would have been attributed to something else. Syed highlights three primary reasons for medical error:

• the complexity of medicine,
• the lack of resources,
• the rapidity of decision making in medicine.

I agree with the three constraints highlighted by Syed as reasons medical professionals make mistakes but disagree with his reasoning concerning why those constraints lead to medical error. Those constraints do not arise because medicine is more complex than other professions. Nor do they occur because of resource constraints or the need for swift decisions by medical professionals. They arise because medical professionals are not trained to cope with the complexity of their job.

The Complexity of Medicine

While medicine is complex, it is not more complex than most professions. We have been conditioned to believe that the hard sciences are more complex than the soft sciences. The reality is hard science is formulaic. Additionally, the time required to learn a profession does not automatically equate to increased complexity. The time it takes to complete medical education does not necessarily equate to the complexity of the field.

Is a neurosurgeon performing brain surgery in an air-conditioned office in the centre of London performing a more complex task than a firefighter rushing into a burning building with a mother screaming that her baby is inside the building?

Is brain surgery more complex than the 16-year-old kid patrolling the centre of Kabul with Taliban fighters on every rooftop trying to blow his brains out? Is brain surgery more complex than a teenage nursery attendant attempting to calm a screaming three-year-old child left at the nursery for the first time by a weeping mother? Is performing brain surgery more challenging than these situations?

Some may argue that they cannot be compared because they are different. That’s the point. They are separate professions; therefore, the magnitude of complexity for each differs. Granted, the nursery attendant might not be engaged in a life or death task. What about the firefighter or the kid patrolling the streets of Kabul — would you suggest that their tasks are not life or death situations?

Or what about air traffic controllers? Would anyone suggest the surgeon’s work is more complex than air traffic control? What if planes fell out of the sky because of air traffic control errors? Would we shrug our shoulders in acceptance because air traffic control is a complex task?

Despite the complexity of firefighting, patrolling a war zone, or air traffic control, fatalities are reduced in those professions because their recruits are well-trained. The problem with the medical profession — and ultimately why patient outcomes have not improved — is that medical professionals do not receive the level of training commensurate with the demands of their job. Complexity is simply an excuse for inadequate training.

Lack of Resources

At the height of the Covid-19 pandemic, when every newspaper in the UK was plastered with images of ambulances queuing for hours outside hospitals in London, a video of empty hospitals outside of London went viral. Even the Nightingale hospitals were standing idle instead of being staffed and open to patients. Medical professionals were overwhelmed and burnt out in some parts of the country, while in other parts of the country medical professionals were chilling out.

The issue then was not a lack of resources but lack of resourcefulness. Second only to defence, healthcare receives the highest allocation of resources in the UK. So, why does healthcare care lack resources? It is simply because of inaccurate and faulty thinking amongst medical professionals. And what is the root cause of such flawed thinking? The training methodology for medical professionals.

The Need for Rapid Decision Making in Medicine

Syed wrote that medical professionals often find themselves in situations where they need to make quick decisions, leading to medical errors. I wholeheartedly agree with this analysis. However, I question why this is the case. Why do medical professionals make errors when forced into swift decision-making?

There are two answers to this question.

Firstly, the medical profession has failed to understand that the practice of medicine is more than just clinical competencies. Secondly, a medical professional is “conditioned to function like a well-programmed computer that operates within a strict binary framework.”

The military understands that in addition to weapons training, personnel must acquire other relevant training to operate as independent units. They know that a 16-year-old kid manning a checkpoint in the centre of Kabul with a car speeding towards him has no time to call mission control for instructions. He has milliseconds to act or be blown to smithereens. Consequently, military personnel are trained to improvise when faced with uncertainty.

The problem with medicine is that medical professionals are not taught how to improvise under fire. Medical professionals lack the capacity to create workable solutions in chaotic situations. This is one of the reasons A&Es are constantly chaotic. Medicine is not the only profession that demands rapid decision capability. Even though medical professionals are required to make rapid decisions, they are not trained how to do so. It is not the situation; it’s the training.

This word of wisdom from the late Queen might explain this point better:

“Like the small soldier, I was giving a gallantry award…, and I said it was a very brave thing to do… “Oh,” he said, “It was just the training.” And I have a feeling that in the end, probably, that training is the answer to a great many things. You can do a lot if you are properly trained…and I hope I have been.”1: 00:21:32 – 00:22:01

Queen Elizabeth II