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20 days ago

WHAT DOCTORS SAY WHEN NOBODY IS WATCHING: WHAT I LEARNED FROM A ROOM FULL OF UGANDAN DOCTORS By Henry Mutebe As someone who works in public health but is not a medical doctor, I occasionally get the chance of sitting in spaces where these health professionals discuss their work at a depth that many of us outside medicine rarely get to see. Every time I do, I come away with a new appreciation of the profession. A few weeks ago, I attended a mortality audit involving a pre-term baby who had, sadly, passed. This particular experience left a lasting impression on me. For those who may not know what a mortality audit is, it is essentially a structured review of a death. In this case, it was a baby born prematurely who was referred from another health facility and later passed away despite the efforts made to save the child's life. What fascinated me was not simply the process itself, but the honesty, rigor, and depth with which it was conducted. Let me paint for you a picture of what I saw. Basically, consultants/specialists, medical officers, interns, nurses, anesthetists, laboratory personnel, and other members of the care team sat in one room and then the case (the story of the child who had passed) was then presented in detail. The presentation starts from the very beginning. Who was the patient? What was the mother's history? What happened during pregnancy? Were there any risk factors identified during antenatal care? Where was the baby born? What was the condition of the baby at birth? When was the referral made? How long did the transfer take? What condition was the child in upon arrival? What interventions were done? What medicines were given? What investigations were requested? What were the results? At what exact time did each of these things happen? And then the discussion begins. The team goes through the case almost minute by minute. Could the diagnosis have been made earlier? Was the right treatment given? Was it given at the correct dose? Was it given at the correct time? Were the laboratory results accurate? Were they interpreted correctly? Were the machines functioning properly? Had the equipment been serviced? Were oxygen levels monitored correctly? Were there delays in referral? Were there missed opportunities during antenatal care? Were warning signs overlooked somewhere along the patient's journey? It is so detailed that nothing is taken for granted. These guys question a lot of things. They asked so many things but that’s all I could, with my arts mind, remember  And there is a sense in which, despite the honesty with which its done, you feel like people are not looking for someone to blame, but they are looking for lessons. It was that method that got me hooked. What struck me most was the extent to which the discussion was anchored in science, evidence, protocols, and guidelines. At every stage, people would ask: What do the guidelines say? Some Doctor would then state the guidelines on a certain dosage, procedure or issue. There is no gambling! They would ask what is the recommended standard of care? Was the protocol followed? Was there any deviation from established practice? If there was, what was the reason? The discussion was not driven by opinions, seniority, or personalities. It is an examination of what was done mapped against what is recommended to be done. The discussions were driven by evidence. There in that room, its science. They have absolute established guidelines and they do this with such relentless attention to detail. I found that profoundly impressive. The level of care with which every step was examined was extraordinary. Tiny details that many of us would dismiss as insignificant were carefully scrutinized because in medicine, as I learnt during that meeting, sometimes the difference between life and death lies in what appears to be a small detail. Mortality audits hold everyone to account.

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