Your Lifestyle

Still Inspiring: February - John Williamson

I am an old anaesthetist. We’ve been labelled with a whole heap of myths, of course. Like the old quip about, ‘The man half asleep looking after the man half awake.’ But anaesthesia is an absolutely dynamic specialty. It’s given birth to many, many branches of medicine which are now taken for granted. Like intensive care, like pain clinics, like retrieval medicine, like diving medicine, like resuscitation teams. And the work I am doing now - incident reporting.

Incident reporting is a way of discovering how things can go wrong during any human activity, surgery for example and then devising strategies or interventions to prevent those incidents from happening again. Or the frequency of them. It’s been my passion for the best part of twenty years. Anaesthetists have always been motivated to improve safety. There’s a very narrow margin of error for us. Complications occur within seconds or minutes. And most errors are potentially very serious.

But there’s no such thing as a zero risk procedure. I mean, there’s always a risk. You can’t walk across the road and have zero risk. All human beings without exception whatsoever, make mistakes. And such mistakes are completely normal and necessary: we learn from the errors we make. I’ve made mistakes, gosh, I sure have. And I don’t think there’s a living anaesthetist who wouldn’t say the same thing.

Incident reporting is voluntary and anonymous. We have no interest in names or which hospital or which practice. We’re not interested in culpability - we only want to know the mechanisms of the error. Because until you study the mechanisms of a human error you’re never going to be able to prevent it happening again. Better than fifty per cent of all things that happen in healthcare are easily preventable.

Most of the reporting so far is coming from nurses, to their great credit. They’re at the bedside. They’re where the rubber hits the road and many of them have that sixth sense experience which is invaluable. Boy, do I speak from experience. We’ve seen an increase in doctor’s participation recently but doctors still have problems admitting that they make mistakes.

In the past, doctors were reared in a culture where they were told that mistakes were just not acceptable and therefore you don’t make them. And we received the wrong advice for years from our medical insurance people who said, ‘If you make a mistake, admit nothing. Give your name rank and serial number but don’t admit anything.’

This was absolutely the wrong advice. Nothing gets up a patient’s or their family’s noses more than when they think they are not being told the truth. It’s just normal to want to know the truth. I’ve got to say that the media distorts people’s expectations of the medical system, as well. The vast majority of people in the health care system who make a mistake are trying their hardest to do the right thing at the time. That tends to be forgotten and there has been a lot of injustice perpetrated in the past because of this blame approach. When harm occurs it’s never the result of a single error but always a cascade of errors. Often it’s the person at the end of the chain who cops the blame and yet it’s the system that has actually created the situation where the final mistake happens. That’s why corrections have to be applied to the system not to the person.

I retired from clinical medicine at the end of 1998 and spent two years in full retirement (when I’d never been so busy!). Then Prof Bill Runciman rang me and said, ‘We need a hand with the APSF, John…’ (Australian Patient Safety Foundation: incident reporting) and so I’ve been back doing that part-time ever since.

I’m planning to stop work permanently no later than June this year. I’m seventy now and getting past my Use By date. If you stay too long, there’s an element of resentment, in a normal human way. You know, “Is that old bugger still hanging about?’ And when you’re not actually caring for patients, you start to lose the thread of what is actually happening. The advances are just colossal. I mean, my colleagues now are using drugs and techniques that I have no experience with. The human behaviour patterns remain the same but it’s very difficult to remain current. There are great people around who will carry on the work.

My wife is a wonderful long suffering woman - all those years when our children were growing up, we were living in Townsville and I’d be working or going to various meetings every spare weekend. She literally reared our children unaided, I’m ashamed to say. I would do it differently now.

My wife and I missed so much along the way. We are enjoying our company together and that of our children now. Enjoying the time.



For more information visit the Australian Patient Safety Foundation website.