On the case
Dr Graham Howarth, Head of Medical Services (Africa), introduces this issue's round-up of case reports, many of which highlight the importance of working with others
Working effectively with others to ensure patient safety involves thorough handovers, careful delegation and a willingness to revisit colleagues’ decisions or diagnoses, where appropriate.
“Minor operation – major problem” shows how important it is that when delegating, you must be satisfied that the other doctor has the experience, skills and knowledge needed to provide good clinical care.
Similarly, if a task has been delegated to you and you feel concerned about the appropriateness of the treatment, as Dr Q did in this case, you should raise this with your senior colleagues before proceeding – and document this. Challenging a colleague’s diagnosis or treatment plan can be daunting, particularly for junior doctors. However, it is imperative to do so if you feel patient care may be compromised.
Poorly-managed delegation can lead to adverse outcomes not only when performing clinical procedures, but when taking informed consent. In “Jotting it all down”, expert opinion did not find Mr Y negligent as a result of Mrs T’s ureteric injury during the hysterectomy, but he was found liable for failing to warn Mrs T of the potential complications involved. Taking consent was delegated to a junior who did not have sufficient knowledge of the procedure. Mrs T was not warned of the possibility of postoperative loin pain and so did not report it straight away, leading to further complications.
Although you may not be accountable for the decisions and actions of those to whom you delegate, you are still responsible for the overall management of the patient and accountable for your decision to delegate.
Sometimes, it is important to refer upwards; in “Mother knows best”, Dr Y did not refer baby T to a senior colleague, despite the mother and baby re-presenting at the Emergency Department (ED) shortly after discharge, and the receptionist in "An age-old problem” did not approach the doctors in the surgery for advice because they were busy.
Doctors need to be aware of their own limitations, but also need to ensure that all staff are aware of their individual roles and limitations.