That is from the Guardian. Technically, the NHS defines this rule as a Rapid Review, since it is planned to work better than established procedures for a 2nd opinion (which were not working so well in the dearth, and were not so available to NHS staff).
Martha's Rule is being rolled out to all adult and paediatric inpatient wards, and is now venturing into the outpatient interfaces.
Central to Martha’s Rule is the right for patients, families and carers to request a rapid review if they are worried that a patient’s condition is getting worse and their concerns are not being responded to.
Martha’s Rule is a patient safety initiative to support the early detection of deterioration by ensuring the concerns of patients, families, carers and staff are listened to and acted upon.
Martha’s Rule is not a second opinion. A second opinion is an already established process where patients, families or carers can choose to see another healthcare professional after they’ve been given a diagnosis or treatment plan for a medical condition.
Looks like performance theatre to me. The odds of a second opinion correcting mistakes are very low in most cases. Medical education, training and workplace culture have maximized conformity, pushed it beyond reasonable limits, to the point where the same biases and mistakes are guaranteed to be repeated in most contexts. Especially under an emergency context in which proper review is not possible because a decision has to be made now now NOW.
The idea for this monoculture approach seems to be that it doesn't matter much which physician someone consults with, they are all trained to think the same way and apply the same thinking and so provide the same baseline level of quality. To the point where all the biases and fallacies will be repeated. It actually looks a lot like the problems in agriculture and animal breeding, where emphasizing some quality traits at the expense of all others leads to dead-ends, because with those traits naturally come weaknesses and a low capacity for adaptation.
It might work out in as many as 5% of cases, maybe, but it's just not how the industry works. It's nothing like judicial review, from which the concept seems to be borrowed. Judicial review is often a long, drawn-out process where everything is checked again, if needed by a panel of judges, and there are plenty of different viewpoints in that industry. In an emergency health care setting, a decision has to be made, now, and it will usually be done by a colleague, trained to think the same way, working in the same workplace culture, rules and leadership. So it's more like doing copy-paste-paste.
And for sure soon enough the idea will spring that AI could offer that 2nd opinion, or maybe a 3rd opinion on top, but by the time this idea becomes plausible, the notion of not relying on AI as a first opinion will already look dangerous. Human judgment is awful at the best of times, and medicine is simply too hard to work out manually. There is no human solution to the problems that exist today, only superior intelligence can achieve this without simply repeating the same mistakes for the same reasons with the same intent.
Looks like performance theatre to me. The odds of a second opinion correcting mistakes are very low in most cases. Medical education, training and workplace culture have maximized conformity, pushed it beyond reasonable limits, to the point where the same biases and mistakes are guaranteed to be repeated in most contexts. Especially under an emergency context in which proper review is not possible because a decision has to be made now now NOW.
It seems like there’s an actual helpline that you can call to get to talk to an independent team. So that might actually help with some of the cultural issues.
Yes, hopefully. It wasn't only families that couldn't escalate cases; concerned nurses couldn't do it either without backing from a doctor, often the same individual who didn't think it was justified. It's not easy to stop things going wrong due to insufficient staff or resources, but at least rigid hierarchies can be dealt with.
Martha’s rule, which lets NHS patients, staff and relatives request a review of their care, is being expanded to every A&E in England, health officials have announced.
The system gives patients, their loved ones and health workers the right to ask for a different medical team to examine the care being provided on inpatient wards and to recommend changes. It has already potentially saved hundreds of lives, official figures show.
Sorry, if I am being obtuse, but I am finding the poll confusing. Is it asking if we think extending Martha’s rule to A&E (ER) a good idea, or is it asking if we have had experienced a situation where we would have wanted a second opinion or are you currently in a situation where you need a second opinion?
The definition of a "2nd opinion" came from the Guardian newspaper.
Technically, the NHS defines this rule differently, since it is planned to work better then the established procedure for a 2nd opinion, which was not working so well in the dearth, and was not so available to NHS staff. I need to look closer at the NHS definition.
Edit: aha - it is a Rapid Review, not a 2nd opinion
Martha's Rule is being rolled out to all adult and paediatric inpatient wards, and is now venturing into the outpatient interfaces. Here is the NHS factsheet on the rule:
"Martha’s Rule is not a second opinion. A second opinion is an already established process where patients, families or carers can choose to see another healthcare professional after they’ve been given a diagnosis or treatment plan for a medical condition".
No, @Peter T, not at all obtuse. My question was obscure, for lack of perspective, and it needed more than the Yes or No options.
Bearing in mind your initial advice upon my 1st s4me poll, I had thought of consulting everyone on which questions to ask, but ...... words failed me. ..
I did mean: "Are you currently in a situation where you need a neutral 2nd opinion?". Yes or no as the only options did need clarifying. Thankyou for forming the 3 questions that might arise.
Unable to edit the poll title, I added your questions to the poll as extra options, made a little error which Hutan removed for me, and Hutan added the A and B options - that @Hutan, saving bacon again.
Question A.a is does the respondent - or their other person - have a suspected or diagnosed ME/CFS and/or Long Covid condition
I am not sure if one can consult on how to format poll questions in a new thread, before adding a poll to the thread.
Happily Bacme concluded: "“Most of all, we hope that the NHS can improve recognition of these issues and address them before they become life-threatening".
DHSC's Campaign Resource Centre published a national communications toolkit for hospitals implementing Martha’s Rule:
More is in the pipeline for implementation in maternity and neonatal units. So these independent Rapid Review Teams do need to be very very very well informed
There is a case of lethal confusion where someone died at home of starvation / dehydration for lack of a standardised 2nd opinion procedure - with no confidence to ask for an ambulance to A&E. The GP likewise dared not insist. Both were unspeakably shocked.
Since a commercial "ME/CFS clinic" was asked to supply an NHS hospital with an outsourced 2nd opinion, concurring on a similar case - BACME as associated surveyed the matter to help prevent potentially lethal risks incurred by misguided errors of 2nd opinion.
As NICE (bio-medical) and BASW (psycho-social) recommend, and as the government "expects", we do not want to risk a potentially lethal 2nd opinion confusing ME/CFS symptoms with the signs of psycho-social harm. To deny any other symptoms, too. So I bolded relevant bits in this briefing:
All the pwME who contributed thought tube feeding helped them and in some cases saved their lives.
Some clinicians seemed to think it was intended a treatment for ME/CFS and therefore not a success if the ME/CFS didn't improve. They seemed to miss the point that it's about preventing deterioration and death.
Sadly there is still a lot of clinician education needed.
One quote from a clinician I found particularly troubling:
Psychological harms,
- increasing dependence
Failure to address underlying drivers
- for both GI and other functional symptoms
Significant investment by some patients
- in maintaining sickness role…
Tube feeding may exacerbate this in some
- but definitely not most.
So according to BACME, pot-luck indicates that 35 clinicians might start to give an opinion, 9 might give an incomplete opinion and 26 might complete the opinion. With at least one outstanding outlier who does not want to apply the bio-psycho-social BASW Guide on Fabricated and Induced Illness. At last, all agreed that FII is rare.
So 2nd opinion stopped saying in civil arenas that there is a lot of it about so it is probable grounds for enforcement. But however rare, there is a procedure to re-assess FII suspicion in cases of suspected or diagnosed ME/CFS.
It is time the Royal Colleges fell in with BASW on BASW's psycho-social procedure to review FII suspicion.
I would also expect the tolerable comfort of any patient to warrant a 2nd opinion if not considered. Especially in A&E. Deterioration can follow if the early warning signs of discomfort are bulldozed.
It is tragic to withhold essentials for fear of indulging a non-existent delusion. This happened in the wild and it happened systematically in hospitals, hence the radical reform in theory and practice.
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