dr probhat chandra sanyal c sanyal oration primu… · dr. b. c. roy, chief minister of west bengal...

Dr Probhat Chandra Sanyal

• Dr. P. C. Sanyal (Probhat Chandra Sanyal) was born in October-1899 in Mymensing (now in Bangladesh).

• He graduated from the Medical College, Calcutta in 1926.

• After this, he went to England for training and higher studies. He passed LRCP and MRCP (Eng) in 1931 and then passed FRCS (Eng) in 1934.

• After this he came back to Calcutta.


• He was connected with Sri. Aurobinda Ashram, Pondicherry even before this, as is evident from the fact that when he registered his Post Graduate degrees in the Register of the Bengal Council of Medical Registration, he gave his address as C/o Sri Aurobindo Ashram, Pondicherry, French India.

Dr Probhat Chandra Sanyal • Immediately with Independence, there was change

in the Medical College. Dr. Sanyal was appointed as the Professor of Clinical and Operative surgery in the Medical College, Calcutta. Dr. B. C. Roy, Chief Minister of West Bengal introduced a new set-up.


• Dr. Sanyal was appointed as the Professor or Surgery, Medical College, Calcutta, in July-1953, he resigned from the post and left Calcutta for good to his permanent abode in Sri Aurobinda Ashram, Pondicherry.


• There he wrote a book in Surgery named “Surgical Text”.

• A “Call” From Pondicherry—Dr. Prabhat Sanyal’s article on Sri Aurobindo’s Mahasamadhi was a poignant article, written at the time of Sri Aurobindo’s last days.

• He led the life of Ashramite and died in July 1978.

Dr Sanjay De Bakshi MS; FRCS (Eng; Edin{ad eundem}) Head of Division of General and GI surgery CMRI; C K Birla Hospitals. International Surgical Advisor & Examiner Royal College of Surgeons of Edinburgh.

• Credit must go to the Parisian pathologist and clinician

• Auguste François Chomel (1788-1858).

WRONG SIDE SURGERY

• On May 26 1995, Rajeswari Ayyappan, the 59-year-old mother of the Indian actress known as Sridevi, underwent surgery for a malignant tumor on the left side of her brain. The tumor, however, was left intact because her neurosurgeon took another patient's X-rays into the operating room and operated on the wrong side of Mrs. Ayyappan's brain.

• Mrs. Ayyappan was transferred to New York Hospital-Cornell Medical Center, where another surgeon removed the tumor.

• A spokeswoman for Memorial Sloan-Kettering, Christine Westerman, said that the neurosurgeon, whom she would not identify, had lost surgical privileges and that the case had been referred to the New York State Department of Health.

MEDICAL ERROR • Medical error has been defined as an

– unintended act (either of omission or commission) or one that does not achieve its intended outcome,

– the failure of a planned action to be completed as intended (an error of execution),

– the use of a wrong plan to achieve an aim (an error of planning), or

– a deviation from the process of care that may or may not cause harm to the patient.

Patient harm from medical error can occur at the individual or system level.

Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US BMJ 2016; 353. Johns Hopkins; Baltimore

• A young woman recovered well after a successful transplant operation.

• However, she was readmitted for non-specific complaints that were evaluated with extensive tests, some of which were unnecessary, including a pericardiocentesis.

• She was discharged but came back to the hospital days later with intra-abdominal haemorrhage and cardiopulmonary arrest.

• An autopsy revealed that the needle inserted during the pericardiocentesis grazed the liver causing a pseudoaneurysm that resulted in subsequent rupture and death.

• The death certificate listed the cause of death as cardiovascular.


CASE HISTORY

• Mr X, a 56 year old gentleman referred to Dr Gawande for a bile duct injury to the Harvard Medical Center in a very critical condition with incipient liver failure.

• Admitted in ICU and treated aggressively.

• On the eleventh day when it was being planned to take him off the ventilator, started spiking temperature and went into fibrillation.

• Lines ALL changed, ALL came back infected.

REALITY OF ICU CARE

• 4% of lines in ICU become infected.

• 80,000 line infections a year.

• 5% to 28% FATAL.

• After 10 days on a ventilator 6% develop an infection.

• Death occurs in 40% to 45%.

• 10% of patients develop an infection after Urinary catherisation in American ICUs.

REALITY OF ICU CARE

• It is estimated that each patient in ICU requires some 178 daily tasks!!

• In a 20 bed ICU it means some 3560 procedures EVERY DAY, each one having a potentiality for going wrong.

Bhatia N. “Manual of ICU procedures” edited by Mohan Gurjar. J Anaesthesiol Clin Pharmacol 2018;34:426-7.

SIZE OF THE PROBLEM

• Medical error is not included on death certificates or in rankings of cause of death.

• NO ICD CODE FOR MEDICAL ERROR.


SCREAMING HEADLINES

E.T.

MORE OF THE SAME

A REALITY CHECK

• 30th October 1935, in Ohio.

• Model 299 being tested for the first time, stalled and crashed, killing two of five crew members.

• The problem was “pilot error”.

PILOT’S CHECKLIST

SURGICAL SAFETY CHECKLIST

SURGICAL SAFETY CHECKLIST

• SURGICAL SAFETY CHECKLIST

• Nursing staff trained to do it.

• SENIOR LEVEL NURSE – who is not going to be intimidated by an indifferent “senior surgeon”.

Circa 2003 A.D.

• An English barrister and former High Court Judge and President of the Council of The Inns of Court. She was the judge who prepared The Shipman Inquiry, a report on the activities of the British serial killer Harold Shipman.

Dame Janet Hilary Smith, DBE, PC

Circa 2003 AD

• In the First Report of the Shipman Inquiry, I disclosed my finding that Shipman had killed at least 215 of his patients over a period of 24 years.

• It was clear that the current arrangements for death registration, cremation certification and coronal investigation in England and Wales had failed both to deter Shipman from killing his patients and to detect his crimes after they had been committed.

Circa 2007 AD

• Only when Shipman forged the will of one of his victims was serious action taken to unmask his activities.

• The Police, the Coroner, the Concerned colleagues,

• THE SYSTEM

• HAD ABYSMALLY FAILED TO PROTECT SOCIETY.

NATIONAL PATIENT SAFETY IMPLEMENTATION

• There is a 1 in 1,000,000 chance of a traveler being harmed while in an aircraft. In comparison, there is a 1 in 300 chance of a patient being harmed during health care.


• Patient safety has been recognised as one of the key important components of quality of care and many initiatives have been taking place at central and state levels to address diverse issues of patient safety.


• In 2015 during the 68th WHO Regional Committee for South-East Asia all Member States of the Region, including India, endorsed the “Regional Strategy for Patient Safety in the WHO South-East Asia Region (2016- 2025)”

STRATEGIC OBJECTIVES • Strategic Objective 1: To improve structural systems to support

quality and efficiency of healthcare and place patient safety at the core at national, subnational and healthcare facility levels.

• Strategic Objective 2: To assess the nature and scale of adverse events in healthcare and establish a system of reporting and learning.

• Strategic Objective 3: To ensure a competent and capable workforce that is aware and sensitive to patient safety.

• Strategic Objective 4: To prevent and control health-care associated infections.

• Strategic Objective 5: To implement global patient safety campaigns and strengthening Patient Safety across all programmes.

• Strategic Objective 6: To strengthen capacity for and promote patient safety research.

NATIONAL PATIENT SAFETY IMPLEMENTATION FRAMEWORK

STRUCTURAL SYSTEM FOR QUALITY AND SAFETY

STRUCTURAL

SYSTEM

LEGISLATIVE

REGULATORY

QUALITY

ASSURANCE

COMMUNICATION

PATIENT ID

PATIENT

CENTERED CARE

ASSESMENT AND REPORTING OF ADVERSE EVENTS

ADVERSE

EVENTS

GENERATING EVIDENCE

ROBUST

SURVEILLANCE

LEGISLATE SAFETY

SURVEILLANCE

SYSTEMS

COMPETENT AND CAPABLE WORKFORCE

WORKFORCE

EDUCATION

TRAINING

APPLYING

PATIENT SAFETY

NORMS

CONTROLLING HEALTHCARE INFECTIONS

HEALTHCARE INFECTIONS

PERVASIVE

PROGRAMS

EQUIPMENT

PATIENT CARE

CLEAN & SAFE

ENVIRONMENT

STRENGTHEN PATIENT SAFETY ACROSS ALL PROGRAMS

1. Safe surgical care.

2. Safe childbirth.

3. Safe injections.

4. Medication Safety.

5. Blood Safety.

6. Medical device safety.

7. Safe organ, tissue and cell transplantation and donation.

PROMOTE PATIENT SAFETY RESEARCH

1. Consolidation of patient safety research and utilization for decision-making.

2. Reinforcing research for patient safety.

FUTURE SHOCK SYNDROME

• “Millions of ordinary, psychologically normal people will come into an abrupt collision with the future.”

Alvin Toffler - 1970

If the entire 5 million years is divided into 62 year lifetime periods, the maximum change occurred in

the last 4 and the fastest in the LAST!!!!

0

200

400

600

800

SPEED OF CHANGE

LIFETIMES @ 62 years

REMEMBER THE

ANGELCHIK

A new surgical procedure

for the treatment of

gastroesophageal reflux

and hiatal hernia.

Angelchik JP, Cohen R.

Surg Gynecol Obstet. 1979 Feb;148(2):246-8

Treatment of symptomatic gastroesophageal reflux using the Angelchik prosthesis.

The Angelchik prosthesis in this series has been safe, simple, and reproducible, and can eliminate the symptoms and signs of gastroesophageal reflux.

Ann Surg. 1982 Jun;195(6):686-91 Starling JR, Reichelderfer MO, Pellett JR, Belzer FO.

Angelchik prosthesis revisited.

Varshney S, Kelly JJ, Branagan G, Somers SS, Kelly JM.

World J Surg. 2002 Jan;26(1):129-33.

Between October 1983 and January 1994, 65 patients (45 men and 20 women)

aged between 29 and 84 years (mean 52 years) had an AP inserted for

gastro-oesophageal reflux (GOR) with or without hiatus hernia (HH).

0%

5%

10%

15%

20% 15%

12%

17% 20%

8%

COMPLICATIONS

Removal

Tr Dysphagia

Perm dysphagia

Distal slip

Prox slip

RESULTS

53%

20% 20%

7%

0%

10%

20%

30%

40%

50%

60%

I II III IV

VISICK GRADING

In view of poor long-term results and high incidence of complications as compared to other conventional operations for GOR, we cannot recommend the continued use of the AP

MISSION ASI 2019

• Enhancing Safety of Patients

– Reduce Hospital Acquired infections

– Reduce Complications in Surgery

– Reduce Medication Errors

– Reduce Antibiotic Misuse

– Enhance Patient Satisfaction

MISSION ASI 2019

• Enhancing Safety of Surgeons

– Security for Surgeons

– Avoid Litigation & Violence

– Patient to Doctor disease transmission

– NABH Accreditation of small and medium sized hospitals

MISSION ASI 2019

• Developing skills

– Professional skills

– Soft skills including communication skills

– Academic skills

– Data management skills including record keeping

• Mentoring residents

• Training / Skill enhancement of Nurses & Paramedics in tier II & tier III cities

What makes an Excellent Surgeon?

Sir Barry Jackson was the Serjeant Surgeon to the Queen from 1991 to 2001 and President of The Royal College of Surgeons of England from 1998 to 2001.

What makes an Excellent Surgeon?

• Even quite recently, it was said that success in the private sector demanded the three A’s— – availability, – affability and – ability,

in that order. • And it remains true that

many GPs judge surgeons by different criteria than do surgeons themselves.

What makes an Excellent Surgeon? 1. Very good technical skill. 2. First-class judgement. 3. One who knows when not to operate. 4. Calmness of the mind and bearing in an emergency. 5. Humility and moral courage, by the need to call for

further skilled assistance when faced with an emergency.

6. Team working. 7. Critical analysis of one’s personal outcomes should be

second nature throughout a surgeon’s career. 8. Need to be able to adapt to the new and learn

continuously. 9. Communication skills are vitally important. 10. Golden Rule, “do unto others as you would have done

unto yourself”.

ASI GUIDELINES

• ASI Whitepaper on Guidelines for Emergency Management of Surgical Conditions under the aegis of the Department of Health and Family Welfare. Govt of India.

Makings of an Excellent Professional

• Years of training and support helps- when situations go beyond he book.

“SULLY” - MIRACLE ON HUDSON Makings of an Excellent Professional

PRIMUM NON NOCERE • “Every surgeon carries within

himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.’

• René Leriche, La philosophie de la chirurgie, 1951”

dr probhat chandra sanyal c sanyal oration primu… · dr. b. c. roy, chief minister of west bengal...

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