I read this morning that in England “Every 15 minutes, on average, a patient with learning disabilities was restrained in hospital last year.” https://www.bbc.co.uk/news/uk-54848098 Patients were restrained 38 000 times in 2019, an increase of 16 000 from 2017. NHS England has encouraged the reporting of episodes of restraint, so some of the increase may be changed reporting rather than more incidents. We don’t know. Reading this brought back two memories.
One was of an editorial I wrote in the BMJ in 1997 https://www.bmj.com/content/314/7075/164:
Don’t treat shackled patients
And keep trying to understand what the Nuremberg trials taught us
“Last week Britain was shocked by the report of a young man who was shackled to a bed until two hours before he died of stomach cancer. He was shackled because he was a prisoner. Last year doctors and others had to protest about women prisoners being forced to give birth while shackled. Understandably doctors unused to treating prisoners in NHS hospitals are not sure about “the rules.” But they should be. Doctors should simply refuse to treat patients who are shackled, and doctors’ organisations should support them without quibble. This is the state making doctors participate in unethical acts in the way that was described in the BMJ‘s December 7 issue marking the 50th anniversary of the Nuremberg doctors’ trials.”
Very short, very blunt.
Another memory was of Christmas 1976 when I was working as a junior doctor in the Eastern General Hospital in Edinburgh. I’d started work in August and was inexperienced. We had admitted a man who had been a heavy drinker. He may have had a heart condition, I can’t remember. Heavy drinkers are at risk of delirium tremens (the DTs) when admitted to hospital—because they suddenly have no access to alcohol.
The first sign that the man was developing the DTs was when he reported rats running up his bed clothes. I can’t remember how we treated him or, indeed, whether we treated him, but whatever we did it wasn’t effective. He became very disturbed, leaping out of bed, and pulling out his drip, so that blood flowed from his arm.
“We’ll have to jump him,” said the registrar. “Remove your tie.” It’s the command to remove my tie that I remember most vividly from that event.
“Because he might strangle you with it if you don’t.”
I took off my tie, and we pursued the man. We grabbed him and pulled him to the floor. He was raging, but he was old and weak. I was able to hold him down while the registrar injected him with something, I can’t remember what. We held onto him for a while, but he quickly became drowsy. We carried him back to bed.
Did we do the right thing? It’s hard to see what else we could have done once he was raging, but if we’d been smarter we would have stopped him developing the DTs.
I remember the incident as exciting.
The moral from these two memories? You draw it.