Casebook Vol. 15 no. 1 - January 2007

Senior MPS Medicolegal Adviser Dr Mark Dudley introduces this issue’s selection of case reports.

First, take a history

It should come as no great surprise that many of this edition’s cases involve a delayed or mistaken diagnosis. An MPS study of negligence claims against GPs in the UK indicates that some 60% relate to delays in making a correct diagnosis, the biggest single category being malignant disease. It goes without saying that a sound diagnostic process must be based upon a sound clinical assessment. In its recently updated advice, the GMC makes it clear that good clinical care must include an adequate assessment of the patient’s condition, taking full account of the history, the patient’s views, an examination where necessary, and further investigations where indicated. Psychological and social factors must also be considered.

It is, of course, not always necessary or possible to make a formal diagnosis, particularly in the early stages of patient care; what is vital is that the patient’ s medical problems are recognised and appropriately managed. The standard by which doctors will be judged, at least in the context of a negligence claim, is well known, and was set out in such leading UK cases as Bolam and Bolitho. Similar legal principles will usually apply in other countries within which MPS members practice.

In essence, doctors are expected to act with reasonable skill and care. Best practice is always the ultimate aim. However, it remains that a doctor should not be held negligent if he has acted in a way that would be regarded as appropriate by a responsible (and logical) body of relevant medical practitioners. When attempting to determine whether a doctor has acted properly, reference is often made to national or local guidelines. Where a doctor has deviated from commonly-accepted practice, a successful defence would usually require supportive expert evidence, provided by practitioners experienced within the relevant specialty. Doctors who practise outside accepted norms must be prepared to justify their actions.

The ancient dictum “First, do no harm” remains as sound as ever. In an era of rapidly developing sophistication in technologically-assisted diagnosis, it is especially important to give due weight to good old-fashioned clinical skills. “First, take a history” may be the order of the day.