Re: Named consultant for hospital patients will end culture of “brief encounters,” says England’s health secretary
Jeremy Hunt's speech at St Thomas' hospital calling for a new model of care in the NHS to tackle the "fragmentation of care experienced by patients in hospital" was based on evidence from a US study showing reduced average length of stay when patients have a named whole stay doctor (1). Why does it seem to take us so long to learn a lesson from history which has been evident for so long?
In 1964 the (in) famous case of the murder of Kitty Genovese was reported in the
New York Times, where a young woman's murder was witnessed by up to 38 people and yet no one helped or indeed called the police (2). This lead to the study of the sociopsychological phenomenon of what would become known as diffusion of responsibilities, also known as the bystander effect. This effect is seen when an individual believes that other people will or should intervene in a situation and therefore relieves themselves of the responsibility to take action. The more people who are present at an event, the less likely an individual will offer help, with further exacerbation by giving the individual anonymity.
Out of hours working, with a number of individuals all vaguely responsible for patient care replicates the perfect environment for diffusion of responsibility. We are concerned that an unintended consequence of Seven-Day Working, which may involve a Consultant taking care of other Consultants' patients, is that there may be a reluctance to intervene once a course of action has begun. The individual responsible for the care of a patient should always be clear and accessible to all involved in that patients's care. This call to individualise responsibility to a doctor is a welcome (if somewhat late) step forward in improving patients' hospital stays.
1. BMJ 2014;348:g1104
2. Gansbery M. Thirty-eight who saw murder didn't call the police. New York Times, March 27, 1964
Dr S J McNulty MB ChB FRCP FHEA
&
Dr P Williams MB ChB FRCP
Consultant Physicians
Rapid Response:
Re: Named consultant for hospital patients will end culture of “brief encounters,” says England’s health secretary
Jeremy Hunt's speech at St Thomas' hospital calling for a new model of care in the NHS to tackle the "fragmentation of care experienced by patients in hospital" was based on evidence from a US study showing reduced average length of stay when patients have a named whole stay doctor (1). Why does it seem to take us so long to learn a lesson from history which has been evident for so long?
In 1964 the (in) famous case of the murder of Kitty Genovese was reported in the
New York Times, where a young woman's murder was witnessed by up to 38 people and yet no one helped or indeed called the police (2). This lead to the study of the sociopsychological phenomenon of what would become known as diffusion of responsibilities, also known as the bystander effect. This effect is seen when an individual believes that other people will or should intervene in a situation and therefore relieves themselves of the responsibility to take action. The more people who are present at an event, the less likely an individual will offer help, with further exacerbation by giving the individual anonymity.
Out of hours working, with a number of individuals all vaguely responsible for patient care replicates the perfect environment for diffusion of responsibility. We are concerned that an unintended consequence of Seven-Day Working, which may involve a Consultant taking care of other Consultants' patients, is that there may be a reluctance to intervene once a course of action has begun. The individual responsible for the care of a patient should always be clear and accessible to all involved in that patients's care. This call to individualise responsibility to a doctor is a welcome (if somewhat late) step forward in improving patients' hospital stays.
1. BMJ 2014;348:g1104
2. Gansbery M. Thirty-eight who saw murder didn't call the police. New York Times, March 27, 1964
Dr S J McNulty MB ChB FRCP FHEA
&
Dr P Williams MB ChB FRCP
Consultant Physicians
Competing interests: No competing interests