ABSTRACT
While rare, incidents of inappropriate and/or unnecessary surgery do occur, so effective surveillance of surgical practice is required to ensure patient safety. This article explores the case of Ian Paterson, a consultant surgeon who was sentenced to 20 years in prison in 2017 for wounding with intent and unlawful wounding, primarily by undertaking inappropriate or unnecessary mastectomies. The article details the main points of the Paterson case, with reference to the subsequent government-commissioned inquiry and its recommendations. It also outlines various strategies for enhancing patient safety, including applying human factors theory, improving auditing, and rationalising NHS and private healthcare. The author concludes that nurses have a crucial role in the surveillance of surgical practice and that combined reporting of surgeons' practice across NHS and private healthcare organisations is required.
Subject(s)
Nurse's Role , Patient Safety/standards , Surgeons/ethics , Unnecessary Procedures/ethics , Consultants/history , Delivery of Health Care/history , History, 20th Century , History, 21st Century , Humans , Nurse's Role/history , Patient Safety/history , Surgeons/history , Unnecessary Procedures/history , Unnecessary Procedures/nursingABSTRACT
The thymus is the last organ in the human body to have its mechanisms fully understood, having had its function fully delineated more than 50 years ago (Miller , Tissue Antigens 63:509-517). Prior to this, the thymus gland has had an interesting history with theories having included a role in fetal growth and development before becoming more sinisterly, a cause of sudden infant death in the late 19th century known as status lymphaticus (Paltauf , Wien Klin Wochenschr 2:877-881). Until Miller (, Lancet 278:748-749) eventually proved its primarily immunological role, the history of this mysterious gland has closely mirrored the history of medicine itself, troubling the minds of pathologists such as Virchow (, Ueber die Chlorose und die damit zusammenhängenden Anomalien im Gefässapparate, insbesondere über "Endocarditis puerperalis," vorgetragen in der Sitzung der Berliner Geburtshülflichen Gesellschaft vom 12) and Grawitz (, Deut Med Wochenschr 22:429-431), surgeons such as Astley Cooper (, The Anatomy of the Thymus Gland) and Keynes (1953, Ann R Coll Surg 12:88), and eminent medical epidemiologists such as Greenwood and Woods [, J Hyg (Lond) 26:305-326]. This article will hopefully be of interest therefore to both clinician and historian alike. Clin. Anat. 29:679-684, 2016. © 2016 Wiley Periodicals, Inc.
Subject(s)
Anatomy/history , Lymphatic Diseases/history , Thymus Gland/anatomy & histology , History, 16th Century , History, 17th Century , History, 18th Century , History, 19th Century , History, 20th Century , History, Ancient , Humans , United Kingdom , Unnecessary Procedures/historyABSTRACT
This paper principally concerns the examination of four English midwifery treatises written by midwives between 1671 and 1795. It focuses on their responses to the medicalisation of childbirth and, in particular, their concerns about medical negligence and their views on the value of anatomical knowledge to the development and defence of their practice. They wrote during a period of mounting tension between midwives and men midwives, when even the most inexperienced men automatically assumed authority over traditional midwives. The texts reveal the authors' concerns about the harm being caused to women and infants by the indiscriminate use of birth instruments. Examples in the primary sources suggest that the practice of both types of midwife ranged from excellent to lethal. However, the midwife-authors perceived men midwives as a threat: unjustly denigrating traditional practice and rapidly carving niches for themselves in midwifery by attending wealthy and influential families, using their birth instruments to intervene and deliver women, sometimes on dubious grounds, and by publishing substantive texts which further promoted their usefulness to society. Foreseeing a medical takeover, the midwife-authors aimed to encourage midwives to be more effective in managing minor difficulties themselves, to avoid families calling in medical aid unnecessarily. They also highlighted the need for more formal education for midwives including basic anatomical knowledge, so they might better defend their practice against a medical attack in a laudable manner. Although the context of practice is quite different today, it will be briefly argued that some of the concerns of the midwife-authors practising in the 18th Century resonate with contemporary concerns about aspects of medicalisation and their insidious effects on women and infants, such as the rising caesarean section rate (Churchill et al., 2006).
Subject(s)
Delivery, Obstetric/history , Midwifery/history , Nurse's Role/history , Parturition , Social Dominance/history , Unnecessary Procedures/history , Adult , England , Female , History, 17th Century , History, 18th Century , History, 19th Century , Humans , Interprofessional Relations , Male , Nurse-Patient Relations , Pregnancy , Professional Autonomy , Social Perception , Young AdultABSTRACT
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