As a doctor you are often dealing with a snapshot in time, and often under significant time pressure. However, it is always worth checking that in carrying out your role, you are taking the whole picture into account.
In many of the cases in this edition, this has been a failure of the doctor, which has led to cumulative errors and a chain of events leading to an adverse outcome for the patient. Often we see claims where the patient has suffered an avoidable harm because of a whole chain of events set in motion by one person failing to act appropriately, or misdiagnosing a condition. This then leads to others relying on that view, even as the picture is changing or not fitting together.
Think of stuffing an incorrect jigsaw piece into a space that is quite similar, yet when you stand back the picture is wrong and often there are missing pieces. If each doctor had looked at the whole picture that was emerging, then the chain of events would have been halted earlier and the outcome for the patient would probably have been better.
When a claim appears before a judge they see the whole picture with all the missing pieces and an adverse outcome. A judge will use the experts to inform him on medical issues and look at the expert opinion, but will apply legal tests and a layman’s view of common sense. With that in mind you will see how easy it is for them to reach a view that if someone had stood back and looked at all that had gone before, and assessed the issues objectively, the chain of events could have been stopped.
Interestingly, having had the opportunity to discuss this with my colleagues who deal with matters before the regulator, ‘reflection’ and ‘insight’ are words that are used repeatedly in that arena. Again, reflection can be the key to a successful outcome.
As a final thought I can see how some may wonder why compensation is still paid even though an eventual outcome for a patient is the same irrespective of the adverse event: “What has been caused?” you may ask. Legal causation is any pain and suffering that flows from an error, and which otherwise would not have been there. So any period of additional pain is compensatable, even if it is hours or days.
I will leave you with these thoughts and let you ponder again on the words we use and their different meanings, as you read the cases.