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Top five medicolegal hazards for junior doctors

Medicolegal-hazards-1Good doctors apply clinical knowledge in a way that is legally and ethically correct – but all doctors can slip up. Here are survival tips for the top five medicolegal risks for junior doctors, writes Charlotte Hudson

Consent

Inexperienced doctors should not feel pressured to do anything beyond their knowledge, experience and competence. This includes obtaining consent for a procedure that they are not familiar with.

Consent is a process, rather than a form-filling exercise. The HPCSA makes it clear that interns should not usually be asked to obtain consent unless the procedure is a minor one that they are familiar with.1

Failure to take consent properly can lead to medicolegal problems including complaints, claims and disciplinary proceedings.

Survival tips

  • Always act in your patient’s best interests.
  • If you take consent, record in the notes what a patient has been told.
  • Use your common sense – consent is patient-specific and depends on the individual’s circumstances, including age, lifestyle, occupation, sporting interests, expectations, etc. It may well be that you are not in a position to advise fully, eg, a professional athlete.
  • Adult patients are presumed competent to consent unless proved otherwise.
  • Any competent adult can refuse treatment.
  • Where an adult patient is deemed to lack capacity to make decisions, reasonable steps should be taken to find out whether any other person has legal authority to make decisions on their behalf. If so, the team should seek that person’s consent to the proposed treatment. If no other person has this authority, your senior colleagues will have to decide what action to take, in the patient’s best interests.
  • A judgment that a patient lacks the capacity to make a particular decision does not imply that they are unable to make other decisions in the future.

Medicolegal-hazards-prescribingPrescribing

Prescribing is fraught with potential pitfalls – from transcription errors and inadvertent dosage mistakes to overlooked drug interactions, allergies and side effects. It is imperative that you have a good knowledge of the pharmacology and the legislation surrounding drugs, and any protocols and controlled drug routines – if unsure, ask.

Survival tips

  • Prescriptions should clearly identify the patient, the drug, the dose, frequency and start/finish dates. They must be legible, dated and signed.
  • Be aware of a patient’s drug allergies.
  • Good handovers require good leadership and communication.
  • Refer to the SAMF.
  • Verbal prescriptions are only acceptable in emergency situations and should be written up at the first available opportunity. If a telephone prescription is necessary, you should make a note of the call in the patient’s notes and records and send a written prescription to the pharmacist without delay.
  • Particular care should be taken that the correct drug is used.

Medicolegal-hazards-confidentialityConfidentiality

Confidentiality is central to maintaining trust between patients and doctors. As a doctor, you have access to sensitive personal information about patients and you have a legal and ethical duty to keep this information confidential, unless the patient consents to the disclosure, disclosure is required by law or is necessary in the public interest.

Survival tips

  • Remember that confidential information includes a patient’s name and address.
  • Before breaching confidentiality, always consider obtaining consent. Take advice from senior colleagues.
  • Doctors can breach confidentiality only when their duty to society overrides their duty to individual patients and it is deemed to be in the public interest.
  • Disclosure of patient information may be required by law, for example to comply with infectious disease regulations.
  • The courts can also require doctors to disclose information, although it would be a good idea to contact MPS if you find yourself presented with a court order.
  • High-risk areas where breaches can occur are lifts, canteens, computers, printers, wards, emergency departments, pubs and restaurants.
  • Be careful not to leave memory sticks or handover sheets lying around.
  • Patient information should be held securely and in compliance with data protection legislation.

Medicolegal-hazards-record-keepingRecord keeping

Good medical records – whether electronic or handwritten – are essential for the continuity of care of your patients. The notes will also form the basis of the hospital’s defence should there be any future litigation against your hospital. Notes are a reflection of the quality of care given so get into the habit of writing comprehensive and contemporaneous notes.

Survival tips

  • Always date and sign your notes, whether written or on computer. Don’t change them. If you realise later that they are factually inaccurate, add an amendment.
  • Any correction must be clearly shown as an alteration, complete with the date the amendment was made, and your name.
  • Making good notes should become habitual.
  • Document decisions made, any discussions, information given, relevant history, clinical findings, patient progress, investigations, results, consent and referrals.
  • Medical records can contain a wide range of material, such as handwritten notes, computerised records, correspondence between health professionals, lab reports, imaging records, photographs, video and other recordings and printouts from monitoring equipment.
  • Do not write offensive or gratuitous comments. Only include things that are relevant to the health record.
  • Patients have a right to access their own medical records under the Promotion of Access to Information Act 2000.

Probity

Medicolegal-hazards-probityDoctors must be honest and trustworthy when signing forms, reports and other documents. You should make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents, and must not deliberately leave out anything relevant. You may encounter families who don’t want certain information visible on the death certificate, but doctors have a legal and professional obligation to complete the certificate truthfully.

Survival tips

  • Probity means being honest and trustworthy and acting with integrity.
  • Be honest about your experiences, qualifications and position.
  • Be honest in all your written and spoken statements, whether you are giving evidence or acting as a witness in litigation.
  • You must be open and honest with any financial arrangements with patients and employers, insurers and other organisations or individuals.
  • Never sign a form unless you have read it and you are absolutely sure that what you are saying is true.
  • If you are uncertain double check your work with a senior.
  • Assume that all records will be seen by the patient and/or others, eg, the HPCSA or a court.

Read the full version of this article in Avoiding easy mistakes: Five medicolegal hazards for interns and Community Service Medical Officers.

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