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Casebook Vol. 21 no. 2 - May 2013

From the case files

Dr Ming-Keng Teoh, Head of Medical Services (Asia), introduces this issue’s round-up of case reports

After listening to your feedback, we have made some changes to the format of this edition’s case reports, expanding the narrative to make the clinical detail clearer and including more details of the expert opinion provided for each case.

Expert opinion plays a key role when handling claims for clinical negligence, as it considers whether there was a breach of duty and causation present. By covering this in more detail here, we can further explore why a case was defended or settled. As a result some of the case reports are a little longer, but we hope that the extra reading will prove not only to be interesting, but invaluable in terms of risk management.

A recurring learning point from the following selection of cases is the need to be aware of the risks associated with diagnostic testing. Not only is it important to offer the relevant tests where clinically appropriate, you must record that you have done so in the patient’s notes. The reasons for the test should be clearly explained to the patient when taking informed consent, as should the outcomes and their implications when results become available.

In “Suspected epilepsy: when to warn”, L’s parents were not made aware of the possibility of a diagnosis of epilepsy following their daughter’s fit. They failed to attend for an EEG appointment and they claimed it was not clearly explained to them what the test was for. Expert opinion found that had L’s parents been made aware of the possibility of epilepsy, and been given appropriate advice, they would have prioritised their daughter’s EEG appointment.

Similarly, poor communication in “When normal is wrong” resulted in a claim that could not be defended. When Mr B rang his urologist’s room for his results following a vasectomy, Dr X’s secretary informed him that the report was “normal”. Dr X had forgotten to label Mr B’s path lab test as post-vasectomy, leading to miscommunication and Mrs B’s unwanted pregnancy.

Test results should not be given over the telephone by non-medically trained staff to avoid the potential for incorrect information being given or for misunderstandings, as happened here.

Good communication extends to detailed patient notes. A lack of clear documentation made the case “A failure to monitor” difficult to defend. Remember, if an investigation is not written down, it is hard to prove that it took place.

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