We all associate hospitals as places where we go for treatment to get better. It is then surprising to note in recently published data from Scotland that one in 10 people die in hospital and one in 3 people die within a year of their admission to hospital.

The report from Professor David Clark at the University of Glasgow looked at 10,000 people in 25 Scottish hospitals on one day - March 31, 2010. These numbers will probably be similar in England. Hospitals therefore need to care for people coming to the end of their lives.

Death is a certainty for us all but an emotive subject for many.

Last year the Liverpool Care Pathway for the dying was abolished by the government after criticism that some patients were put on the pathway unnecessarily and that some were deprived of food and drink in their last days.

There is no national consensus on what should take its place. This leaves a vacuum and hospitals are left to devise their own policies and pathways.

I think the most important concern for patients and families is that no one should be put on an ‘End of Life’ pathway without every effort being made to treat their problem and keep them alive. However, once on that pathway they should be made as comfortable as possible.

Communication with the family and empathy are the key – and medical staff need better training to handle these situations well. For patients with terminal cancer the decision to place them on the pathway is easier. It gets more difficult for the elderly admitted with a fractured femur for example who develop another medical problem whilst on the ward. It is difficult sometimes to make a judgement whether the illness is incurable.

Adverse events occur in one in 10 hospital admissions

I recently attended a course on managing adverse events in treating patients. One in 10 patients will have an adverse event in hospital and one in five adverse outcomes have severe consequences.

Fifty per cent of adverse outcomes are preventable. This does mean that 50 per cent may not preventable and are the result of recognized complications of treatment.

The General Medical Council and the NHS say doctors have a duty of care to inform patients if an adverse event has occurred, say sorry and try and make amends. Having an adverse event is of course very stressful for the patient – but also for the doctor concerned.

Feelings of failure , concern for the patient, fear of complaints, fear of being sued all flash through a doctor’s mind. The statistics show that only three per cent of patients who have a serious adverse event end up suing the doctor. Most patients take action to enforce accountability, get an apology, find out what happened and for compensation.

From a patients perspective it is our right to expect a full explanation of what went wrong and an apology. It is also important to be vigilant while we are in hospital and speak up if we are unhappy about something.


Exercise and meditation can prevent the flu

A survey by the London School of Tropical Medicine has found that intense exercise of 20 minutes per day can reduce the chances of getting the flu by 10%. Moderate exercise does not offer the same benefit. 4800 people took part in the survey.

Getting enough sleep, a good diet, and avoiding stress which can run down our immune system are also important.

A similar study funded by the National Institute for Health in America found that regular mindfulness training or meditation, or regular exercise reduced the incidence of flu like illnesses by 30-40 per cent. Vaccination can offer partial protection but only against three strains of the virus.

- Manoj Krishna is a spine surgeon based at the Nuffield Hospital York. For more information about his work please visit www.spinalsurgeon.com