‘Blame for tragic case should not be individualised’: nurses join Denmark doctors’ campaign

A campaign by Danish doctors to overturn a court ruling they see as landmark for the way patient care is conducted has gained the support of nurses and senior colleagues.

'Blame for tragic case should not be individualised': nurses join Denmark doctors' campaign
Composite: Bastian Neesgaard/Facebook; Søren Bidstrup/Scanpix

The Danish Nurses’ Association (Dansk sygeplejeråd, DSR) has stated its official support for a viral campaign started by doctors last week.

The viral campaign, which uses the hashtag #detkuhaværetmig (‘it could have been me') spread on social media as junior doctors and senior colleagues throughout the country oppose a court ruling convicting a junior doctor of negligence.

An online petition supporting the appeal has now been signed by over 9,000 people.

The case in question dates back to the death of a patient at Svendborg Hospital in 2013 in a sequence of events now referred to as the ‘Svendborg case', in which a junior doctor failed to document a verbal request for a basic blood sugar measurement in the patient chart and didn't check that the nurse had followed her instruction.

The patient, who was diabetic, had been admitted for reasons not related to his diabetes and classed a non-emergency case (green on the triage scale in medical terminology).

According to a report published by Fyens Stiftstidende on Friday, the doctor was the only trained medic to read the patient’s records during that sequence of events, with department managers having told nurses they were not required to do this, ostensibly due to time constraints.

The patient was later found unconscious and died nearly four weeks later on September 1st, 2013, most likely as a result of low blood sugar-related brain damage.

READ ALSO: Danish junior doctors start viral campaign to overturn key ruling against colleague

Subsequent police investigation of the sequence of events led to the junior doctor being charged with breaching a medical conduct paragraph relating to “severe or repeated negligence of duty or carelessness in the practicing of duties”.

One of the key issues for protesting doctors is the legal sentencing of a colleague for what is generally considered daily practice – namely, giving instructions verbally.

Making legal pursuit over verbal communication possible would mean that doctors could be sued every day – hence the ‘it could have been me’ sentiment of the protest.

Requiring all verbal instructions to be followed up by doctors to ensure they had been carried out would create an impossible and impractical workload, medics say.

Doctors speaking out in support of their convicted colleague also say she has been made scapegoat for a tragic outcome in a department which has received criticism from the Danish Health Authority for overstretched working conditions.

The campaign has since gained momentum and, on Wednesday, DSR announced its support.

The nurses’ association says that it wants energy to be focused on improving the pressure placed on overburdened doctors and nurses, rather than reducing problems to individual faults.

“We support responsibility being placed as far as laws are broken. But conditions are too strained, mistakes are made because there are so many tasks and so few people. Mistakes caused by poor organisation should not be reduced to individuals,” DSR deputy chairperson Dorte Steenberg told The Local.

“That doesn’t change the fact that this was a terrible situation. But it cannot be corrected by reporting individuals to the police,” Steenberg added.

“The primary reason [for supporting the doctors’ campaign, ed.] is the tendency for staff to be sued for making mistakes. In this case there was a mistake made in the documentation, but there are other types of mistake. Documentation must be done correctly, but it also requires time.

“There would be fewer mistakes of the system allowed immediate documentation. That would make collaboration [between doctors and nurse, ed.] easier,” Steenberg said.

Senior doctors have also gone public with their understanding of younger colleagues’ predicament.

Ulf Hørlyk, head of the Accident and Emergency Department at Horsens Hospital, posted his support for junior colleagues in a video posted to Twitter and Facebook.

In the video, Hørlyk compares punishing doctors working under pressure to forcing bus drivers to break traffic rules and then punishing them for accidents.

The consultant used the alternative #detskalaldrigblivejer (‘it won’t be you’) hashtag to signal to his own subordinates — and junior doctors generally — that he would look to protect them from dangerous pressure at hospital departments.

“I am experiencing a huge amount of uncertainty amongst young doctors, and it’s my responsibility to ensure they are working under a sense of security,” Hørlyk told medical professionals' journal Ugeskriftet.

Doctor Lotte Smedegaard, who started the Facebook support group, was one of the first to post the hashtag.

Smedegaard, who works as a resident doctor at the North Zealand Hospital’s paediatric unit, told The Local that the support of nurses was of “huge significance” for the campaign.

“It shows that this is not just a case of ‘spoiled doctors’ complaining. Our closest and most important colleagues can just as well see themselves in this situation. The petition has also now begun to see a lot of signatures from nurses and students, which shows that this is an issue that means something to those professions,” she said.

Surgical registrar Sedrah Butt, who has been a vocal supporter of the campaign, also welcomed nurses’ support.

“It’s also relevant for the nurses because this judgement – not even this judgement, the patient that died, it happened because both doctors and nurses are under a serious amount of pressure,” Butt told The Local.

“We as doctors must prioritise our work daily. Documentation is important and required by law but it is not in first place – our patients and their health are. We are prioritising all the time at work, and sometimes there are patients who are more sick than others, so we have to focus on them,” she added.

Documenting whether all verbal communication has been executed would create a context of mistrust on hospital wards that would benefit neither healthcare staff nor patients, Butt said.

“Nurses do their jobs well. If we can’t trust them and have to document everything, accident and emergency wards will stop functioning. And we won’t be able to move on. Doctors will only be able to focus on saving themselves legally, not on good patient treatment,” she said.

Smedegaard said that the campaign had evolved since its viral beginnings and now had the potential to improve working conditions and patient safety in Denmark’s hospitals.

“The original idea was to give Mr. and Mrs. Denmark some information about this issue, and it slowly seems to be working. But what’s more important is to open politicians’ eyes to this, since it’s they who made the laws that the Danish Patient Safety Authority (Styrelsen for Patientsikkerhed) is now enforcing.

“Our thoughts are that we will go to [Danish parliament] Christiansborg and deliver the signatures to politicians, and hopefully have a constructive discussion,” she said. 


Over 2,000 of Denmark’s doctors are foreign professionals

Almost one in five doctors in rural parts of Denmark was trained abroad. The Danish Medical Association has called for more stringent language requirements.

Over 2,000 of Denmark’s doctors are foreign professionals
File photo: Liselotte Sabroe/Ritzau Scanpix

Statistics Denmark (DST) figures show an increase in the number of doctors working in Denmark who qualified abroad, newspaper Jyllands-Posten reported on Friday.

A total of 2,100 foreign-trained doctors working at Danish hospitals and general practices in 2017 represents an increase of 300, or 19 percent, since 2010.

The Danish Medical Association’s chairperson Andreas Rudkjøbing said the figures show the Danish health sector’s increasing need to recruit specialist medics.

“This reflects that it has not been possible to meet our needs with (Danish)-trained doctors, which has thereby made it necessary to fill vacancies with foreign-trained doctors. The Danish health system is completely dependent upon our foreign colleagues,” Rudkjøbing told Jyllands-Posten.

According to the DST analysis, 18 percent of hospital doctors and GPs in rural municipalities were foreign nationals who took their qualifications outside of Denmark. The national average was somewhat lower at 9 percent.

Rudkjøbing said the key consideration is quality of service, rather than the proportion of foreign doctors.

“The gauge is delivery of high quality treatment and high patient safety,” he said.

The most common nationality for the foreign-trained doctors is German (247 doctors) followed by Polish (219), then Iraqi (163), Lithuanian (156) and Russian (109).

The top 10 includes three non-European countries: Afghanistan and Iran in addition to Iraq. Hungary, Romania and Norway complete the top ten.

Current rules require doctors trained outside of Nordic countries and the EU to pass a series of courses in order to be granted authorization to practice medicine in Denmark. These include Danish language tests as well as tests relating to medical knowledge and Danish medical law.

Doctors who studied in the EU or the Nordic region are exempted from these courses and are able to gain authorization largely automatically under EU law, the Danish Patient Safety Authority states on its website.

That means individual employers – the health authorities known as Regions, in the case of public hospitals – are responsible for assessing the linguistic skills of medics before hiring them.

Rudkjøbing told Jyllands-Posten he is in favour of Danish language tests also applying to EU-trained doctors.

“You can end up in a situation in which a doctor is employed without having the necessary linguistic competencies to carry out the role. We have asked the minister for health, and parliament, to tighten the rules so we don’t end in such a situation,” he said.

The Social Democrats, Danish People’s Party and Red Green Alliance – who each represent different parts of the political spectrum – all said prior to June’s general election that they would support such a measure.

READ ALSO: Foreign doctors must meet Danish language standards: minister