Blunders by trainee doctors a systemic problem, says Lo

Adelyn Lau

Secretary for Health Lo Chung-mau acknowledged a systemic problem in the training of medical students as public hospitals recorded two incidents of misplaced nasogastric tubes involving trainee doctors within four months.

The blunders were linked to clinical training at two medical schools in Hong Kong, Lo said, with health authorities now set to review the training with the University of Hong Kong and the Chinese University of Hong Kong medical faculties to ensure medical students gain sufficient clinical experience before starting out as trainee doctors at public hospitals.

A patient rights advocacy group suggested interns should not perform the procedure, including determining the position of the nasogastric feeding tube - a thin, soft tube that goes in through the nose, down the throat, and into the stomach - in X-ray images, and should have more senior doctors do them.

Speaking at an event yesterday, Lo disagreed with the one-size-fits-all approach.

"I believe this is not the most thorough solution to the problem; it merely shifts the responsibility up a level," he said.

"If interns cannot effectively carry out clinical procedures during their training or even take on responsibilities, they will not become experienced and capable doctors," he added.

Lo indicated that to improve the process, not only will senior doctors support them, but interns are also encouraged to proactively seek advice from their superiors.

Saying that 590 medical graduates undergo internships in public hospitals each year, the health minister has instructed the Hospital Authority to quickly provide training within this month, particularly on enhancing their ability to handle clinical procedures, with the hope of making immediate improvements in service quality.

He also noted that the two incidents of incorrect nasogastric tube insertions involving trainees should no longer be seen as isolated or personal issues.

"It has become not just an individual incident, and it may not be a personal problem, but rather a systemic issue," Lo said.

He believes that the operations and judgments involved in the two blunders by medical interns may be related.

The root of the problem may involve training, Lo said, citing that in the future, he will work with HKU and CUHK medical schools to review their programs and ensure that medical students gain sufficient practical experience to qualify as interns at hospitals.

He said that medical schools are the most important base for cultivating talent, and authorities place great importance on the role of medical schools in training professionals who meet the required standards.

In the most recent blunder, a 76-year-old male patient at Pamela Youde Nethersole Eastern Hospital had a nasogastric tube incorrectly inserted into the bronchus last Wednesday. He was in critical condition but gradually improved after treatment.

The intern did not notice the misplacement of the tube while reviewing the X-ray scan, which resulted in laxatives being infused into the patient's lungs. The patient had to stay at the intensive care unit, a spokesman for the public hospital in Chai Wan said.

A panel will be set up and an investigative report will be submitted to the Hospital Authority Head Office in eight weeks, the spokesman added.

In another incident discovered on June 18, the nasogastric feeding tube of a 61-year-old male patient with paralysis caused by an injury of the cervical spinal cord, at Queen Elizabeth Hospital was misplaced into his left bronchus, critically injuring him, a hospital spokesman said.

A root-cause analysis panel recently reviewed the findings of the chest X-ray examination after the nasogastric tube was inserted and found that the X-ray could not fully show the tip of the tube.

The panel said the intern did not have sufficient clinical experience to interpret the malposition.

The HA accepted its recommendations and will review clinical guidelines.

adelyn.lau@singtaonewscorp.com