Hong Kong health chief vows to strengthen training for intern doctors after medical blunders
Hong Kong Free Press
Hong Kong’s health minister has vowed to step up training for intern doctors, after public hospitals reported two medical blunders involving trainees in four months.
The Hospital Authority will enhance training on inserting nasogastric tubes for intern doctors this month following two medical mishaps at public hospitals, Secretary for Health Lo Chung-mau said on Sunday.
Lo apologised to the affected patients and said the incidents involving intern doctors misreading X-rays showed the existence of a “systemic problem.” The authorities would review whether the two public hospitals involved had provided sufficient training, he added.
“Every year, there are 590 medicine graduates doing internships at hospitals under the Hospital Authority… we have to make sure the graduates are all fit for practice,” Lo said in Cantonese after a sports event organised by the Hong Kong Transplant Sports Association.
The health chief’s remarks came after Pamela Youde Nethersole Eastern Hospital reported last Thursday that an intern doctor had accidentally inserted a nasogastric tube, sometimes used to administer medicine, into the bronchus of a 76-year-old male patient. The trainee was said to have misinterpreted the chest X-ray findings, and had been unable to identify the misplacement of the tube.
The patient, who was admitted to the hospital for a colonoscopy, had developed abdominal pain and shortness of breath after the medication entered his lungs. The hospital later found the misplaced tube following a re-examination of the chest X-ray.
The blunder had left the patient in a critical condition but the hospital said he had gradually improved after treatment.
It was the second incident involving an intern doctor at a public hospital in less than four months. In June, Queen Elizabeth Hospital reported that the condition of a 61-year-old male patient had deteriorated two days after a nasogastric tube for feeding formula milk incorrectly replaced by a nurse went unnoticed. Upon investigation, it was found that the tube had been inserted in the patient’s left bronchus.
The patient was sent to the Intensive Care Unit and was in a critical condition.
Around two months after the incident, the Root Cause Analysis Panel set up by the hospital concluded that the nasogastric tube may have passed through the bronchus and entered the left pleural cavity. The tip of the tube did not fully show on a chest X-ray examination conducted after the tube reinsertion.
The panel said the on-duty intern did not have sufficient clinical experience to interpret the position of the tube, and could not detect its replacement. Better training and guidance for interns in interpreting chest X-ray exams should be provided, while the system should ensure that case doctors reviewed the X-ray results of high-risk patients, the panel suggested at the time.
Responding to suggestions that X-ray examination should be conducted by more senior doctors instead of interns, Lo said on Sunday that it was not the “most thorough way” to address the issue. He also disagreed with the “blanket approach” of barring intern doctors from practising when issues arose.
“It merely postpones and shifts the responsibility to a higher lever. If our intern doctors cannot effectively perform or bear certain responsibilities during their internship, they won’t be able to become experienced and able doctors,” the health chief said.
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