Commentary | Health Services does good work

Human error is real, but our practitioners are not incompetent

I am responding to Aaron Vansintjan’s allegation that McGill Student Health Services “almost killed” him (“McGill Health Services almost killed me,” Commentary, October 28).

It is always distressing to hear that any student has suffered as a result of illness, but I feel it is necessary to respond to the criticisms raised about the service we provide.

First, McGill Student Health Services does provide same-day appointments for students who are not feeling well. A student who comes in will be seen by a triage nurse, and, depending on the problem, will either be given an appointment later that day to see a nurse or a physician, or be sent home with the proper advice. The system was implemented as a result of student feedback. Prior to this, students who came in essentially had to wait at Student Health – often for hours – to be seen. Now, students can leave the clinic and attend classes, otherwise do their work, or go home to rest.

Second, students come early to the same-day appointment clinic because there are only a limited number of appointments available. During the academic year, we try to have the equivalent of 1.5 doctors seeing drop-in patients every day. We would like to have more, but we are unable to recruit other physicians, simply because there are not enough physicians working in Montreal – a shortage beyond our control. Recognizing that, we have trained our nurses to do gynecological exams, prescribe contraceptives, and screen men and women for sexually transmitted infections, which frees time for some of our physicians to see other patients.

Third, our nurses follow strict protocols consistent with the current medical literature when screening and evaluating students. Students are either referred to a physician for assessment or sent home with advice, including the advice to return to clinic if symptoms worsen. But nurses always err on the side of safety.

Fourth, medical conditions are dynamic, not static. In this case, the initial assessment was most probably the proper diagnosis of what was then a simple viral infection – a cold, not pneumonia. At this point, most students get better, but a small number don’t. Vansintjan reported that he returned another day for a medical note, but a second nurse determined that he should be seen by a physician, and the physician diagnosed pneumonia and treated him. I am sure the proper, broad-spectrum antibiotic that would treat the “atypical pneumonia” most common in young people was prescribed. But, even despite proper treatment, a medical condition may sometimes worsen for a number of possible reasons – e.g., because of another medical problem or more commonly because the organism is not sensitive to the prescribed antibiotic.

Fifth, routine use of chest X-rays in these situations is not recommended. Guidelines from the Canadian Infectious Disease Society recommend chest X-rays only if the diagnosis is clinically obscure or uncertain – apparently not the case here.

Finally, there is no easy way, such as testing a sample of blood or sputum, to determine what bacteria are growing in the lungs, so antibiotics can only be prescribed based on criteria such as age, severity of illness, and the region where the person lives. The only way to determine if the proper antibiotics are being used is to monitor a patient’s progress and response to the drugs.

The service that my staff offers is excellent and the service students get at Student Health is better than what most Quebec residents receive. Nonetheless, I invite all students to get in touch with me if they have any concerns or suggestions as we feel feedback allows us to improve our service.

Pierre-Paul Tellier is a professor of Medicine and director of the McGill Student Health Service. You can write to him at pierre-paul.tellier@mcgill.ca.


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