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Casebook Vol. 22 no. 3 -
September 2014

From the case files...

Mark DinwoodieThis edition Dr Mark Dinwoodie, head of member education at MPS, assesses the key learning from the latest collection of case reports

I’m delighted to have the opportunity to reflect on the cases in this edition of Casebook from an educational and risk management perspective. The cases of Mr D, with his osteoarthritic knees (“A pain in the knee”), and Mrs H, with her neuropraxia following cannula insertion (“A cannula complication”), remind us how record-keeping can contribute to an effective defence against allegations of negligence. Of course, good documentation is also increasingly essential to support good clinical care and enable continuity to be delivered by an increasing range and number of involved healthcare professionals.

It is important that not only should the clinical assessment and any procedure be adequately documented, but also the discussion behind any decision made regarding treatment. It is, of course, a matter of judgment regarding how much to write in the notes and, inevitably, time pressures will contribute to that consideration.

There can be a temptation when a patient returns with no improvement to keep adjusting the treatment, whereas sometimes what is needed is a review of the original diagnosis and adjustment of the treatment to match the reviewed diagnosis

The elusive diagnosis” for Mr M turned out to be diabetes in a patient who had repeatedly attended the GP surgery for several infections. While MPS successfully defended this case, it reminds us of the importance of reconsidering the diagnosis in patients who represent with recurring symptoms or signs. There can be a temptation when a patient returns with no improvement to keep adjusting the treatment, whereas sometimes what is needed is a review of the original diagnosis and adjustment of the treatment to match the reviewed diagnosis.

The system errors of Mrs Y and the blood transfusion (“Transfusion confusion”) highlight the importance of someone taking responsibility when the patient has suffered an adverse outcome and, following an apology, having an open and honest discussion with the patient, explaining what has happened. It is always appropriate to say that you are sorry for what the patient has experienced. It also shows how patients themselves can make a valuable contribution to patient safety.

I hope that you find reading the cases to be interesting and informative. Our range of education risk management products can help you address some of these challenges, and I encourage you to go to the Education & Events section of our site for more information.

Casebook aims to promote safer practice by sharing experiences that we hope you will find helpful. MPS publishes medicolegal reports as an educational aid to MPS members and as a risk management tool.

The case reports are based on MPS experience from around the world and are anonymised to preserve the confidentiality of those involved.

The cases described are historic and the expert opinions that follow in specific cases reflect accepted practice at the time. The learning points are applicable today.

If you would like to comment on a case, please email casebook@mps.org.uk

Missing cauda equina

Sep 14, 2014, 09:42 AM
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2 comments
  • By Dr Marimuthu velmurugan on 02 April 2015 04:48

     Avery good valid point every GP should know. I always ask bladder and bowel symptoms and any disorder encounterd by patient as new problems. I must make it  a point to record it legibly,

    a very good example.

    Kind regards,

    Drvel.

  • By Dr.s.z.Haider on 02 April 2015 03:11 This is very good case for learning red flag symptoms in back pain symptoms as ingen practise ten percent patient consultation are with back pain and some timesit is dificult  in10 minutes consultation to assess such patients and it is wise to review the patient Asa special time slot at the end of surgery for detail neurological assessment specially whenpt presents with urinary or bowel symptoms
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