Casebook Vol. 16 no. 1 - January 2008

Head of Medical Services (Leeds) Dr Iain Barclay introduces this issue’s selection of case reports, and how they are written.

I am pleased to be able to introduce the case reports in this issue. We choose the case reports that are published in Casebook with great care. Our intention is not to print the most salacious or the most extreme cases, but instead to publish those which colleagues will find helpful. There should be a “there but for the grace of God go I” moment, one that, we hope, gives pause for your future practice.

To do this, the case reports need to fulfil a number of criteria. They need to be believable, relevant to current practice and offer lessons that can be incorporated into practice.

Sometimes readers suggest that we are out of touch in our advice, but these case reports are based on real experiences. We are merely passing on opinion of experts and the standards of the courts by which cases are judged.

The current credibility of the cases can sometimes present us with a challenge. Cases can take a long time from incident to settlement. As an aside, this is why MPS indemnity means you only need to be a member at the time something goes wrong. Once you have paid your subscription for a particular year, you can then ask for help with an incident that took place during that year, no matter when it comes to light.

By the time the case has been concluded the incident may have occurred ten years ago, or even more, and methods of practice may have changed. To make sure that readers are not distracted by this, and also to ensure that individuals are not identifiable, we extract the nugget of what went wrong from each case. We then commission a practising clinician to frame this into a case report.

So, to take an example from this edition, while the case in “Who’s changed my list” really did involve surgery on the wrong limb after a late change of list, precise details of the patient and the particular surgery have been altered. And while the case occurred several years ago, there is no question that such incidents are still happening today. Indeed in the UK the NHS Litigation Authority reports that the number of wrong-site surgery claims has risen by 50% between 2004 and 2006, and the value of these claims has doubled confirming the importance of the learning points for current practice. This case report therefore presents a timely opportunity to remind colleagues about the importance of checking the procedures that are in place to avoid such events in the future.

As usual, I hope that you find the case reports both interesting, and helpful to your practice.