http://bmj.com/cgi/content/full/324/7333/365/a
BMJ 2002;324:365 ( 9 February )
Letters
Patient safety is more important than efficiency
In his letter Isaac, a staff
anaesthesiologist in the United States, suggests the establishment of
outpatient surgical facilities.1 I am
well aware that "office surgery" has been heavily
promulgated recently in the United States on the grounds of
"efficiency," financial or otherwise.
In the United Kingdom general anaesthesia as an outpatient in the dental
surgery was a constant feature for many years. Most of the original
bickering concerned the low fees paid to the administrator of the
anaesthetic. After 1959 concern focused more on safety. Committees
were formed, commissions appointed, and working parties convened.
All made recommendations, but sporadic, usually avoidable, deaths in
dental surgeries continued to occur.
I participated in several discussions, and it was plain that the solution of
banning general anaesthesia in dental surgeries was unacceptable
because of the effect on the income of the dentist (who often used
to administer the anaesthetic) and the "anaesthetist," where
this was an attending doctor, often a general practitioner. It was
not until 1999, after yet more deaths, that the British government
took the decision to ban general anaesthesia in dental surgeries. It
seems ironic that it took the United Kingdom 40 years to accept
that general anaesthesia is safest when given in a fully equipped
and fully staffed facility when there seems to be an increasing
interest in office based surgery and anaesthesia on the other side
of the Atlantic.
Boulton has given a fascinating account of the story of anaesthesia in the
dental surgery.2
It would be sad to see the problems resurface in the name of
efficiency. Patient safety is more important than efficiency.
John S M Zorab
Holmray Cottage Park Street, Iron Acton Bristol, BS37 9UJ JZorab@compuserve.com
|
1. |
Isaac P. Approach to surgery in United Kingdom should be
shaken up. BMJ 2001; 323: 106 |
|
2. |
Boulton TB. The Association of Anaesthetists of Great
Britain and Ireland 1932-1992 and the development of the specialty of
anaesthesia. London: Association of Anaesthetists of Great Britain and
Ireland, 1999. |
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