News and opinion

Under the influence

MPS Medical Director Dr Rob Hendry reminds doctors of their unique opportunities to influence and inspire those working around them

Doctors are often surprised how influential they are within their teams and organisations. The things they do and say and the way they conduct themselves is increasingly being recognised as central to effective healthcare.

Most medical care is now delivered by teams rather than by individual healthcare professionals working in isolation. When teams work well the results can be spectacular, but when teams are dysfunctional, patient care can suffer. Stories in the press about “failing hospitals” are, in fact, often actually about failing teams.

Sadly at MPS we frequently see members getting into difficulties with their employers and their regulators, not because of their lack of specialist knowledge or poor technical skills, but because of the way they interact with their colleagues.

When relationships break down in healthcare teams not only do things go wrong more often, but when they do the impact on everyone involved is usually much greater.

One of the characteristics of being a professional is taking responsibility for one’s actions. Often, choosing to turn a blind eye to problems within a team can lead to problems becoming magnified and intractable.

Product liability and MPS

Issues with product liability have made the headlines in a number of countries around the world recently – notably the DePuy metal on metal hips in South Africa and Ireland, and the PiP breast implants in the UK.

These issues arose from faulty products, where normally responsibility lies with the manufacturer or supplier of the product.

However, in both cases, attempts were made by claimants to include surgeons in the claims – in the DePuy hips case, the justification given was that the surgeons had failed to properly fit the prostheses; with the PiP implants, the insolvency of the manufacturer was the motivation for involving the surgeons in the claims.

In both situations, whilst MPS is not providing an indemnity for product liability, MPS is supporting members with these cases by doing whatever is possible to prevent the development of litigation targeting clinicians, when other more appropriate sources of compensation (the manufacturer or supplier) are no longer available.

Statements that erroneously imply a lifetime guarantee, for example, can make a clinician liable in the event of a related allegation or claim

In the meantime, members can take steps to protect themselves in the event of a claim for product liability, by retaining documentation relating to:

Evidence of purchase.
Where possible, the serial number of the item in question – it can be used as evidence of the batch of goods obtained.
Terms and conditions.
Express warranties and guarantees.
Instructions and packaging.
Correspondence regarding product specification and any alteration.
Where whole goods are transported by an external logistics company, relevant contracts/terms/correspondence.
Complaints history relating to product and similar products (if relevant).
Order forms, emails, faxes.

Clinicians should also take care regarding any verbal statements made to patients regarding a product. Statements that erroneously imply a lifetime guarantee, for example, can make a clinician liable in the event of a related allegation or claim.

Award triumph for MPS’s Diarmuid Quinlan

January 2013 edition of Casebook.

Dr Diarmuid Quinlan, a GP in Cork and MPS clinical risk assessment facilitator, won the Quality in Practice award at the ICGP annual conference in Galway in May.

Dr Quinlan (left) picked up the award, along with his colleague Dr Paul Ryan (right), for his patient alert on methotrexate. The pair wrote about their study in the January 2013 edition of Casebook.

New president for Medical Council

The Medical Council has elected cardiothoracic surgeon Professor Freddie Wood as its next president.

Dr Audrey Dillon, a non-consultant hospital doctor, has been elected vice-president for the next five years.

In the election, Prof Wood saw off the challenge of GP Dr Ruairi Hanley. A former director of heart and lung transplantation at the Mater Hospital, Prof Wood is currently in private practice. Dr Dillon is in her fourth year of the RCPI Specialist Registrar Training Scheme in general internal medicine and gastroenterology.

Target on lost working days

The Department of Social Protection (DSP) has proposed new guidelines on medical certification, which it says have the potential to reduce working days lost by up to 66%.

Closed Certification Guidelines for General Practitioners for First Time Medical Certification is to be piloted by 200 GPs before being extended nationwide. The six-month pilot programme has been approved by the ICGP Quality in Practice Committee.

According to Dr Clement Leech, Chief Medical Advisor at the DSP, the aim of the guidelines is to prevent people with common health problems progressing to a state of chronic disability.

The term “closed certification” refers to the concept of having evidence-based, defined periods of recovery for common medical conditions, and common surgical procedures. The guidelines cover approximately 80% of conditions that are certifiable; claimants who move off benefits and re-enter the workforce generally experience improvements in income, socio-economic status, mental and general health and wellbeing.

The number of people on long-term illness or disability schemes has increased from 100,000 to 150,000 over the past ten years, and the cost has increased from €700 million to €1.8 billion.

Review findings for professional competence

A review of professional competence schemes by the Medical Council has suggested they focus on identifying and ensuring the early management of doctors whose clinical performance may be a cause for concern.

The review included an examination of competence schemes in other countries. It found that while scheme details are similar for specialists and non-specialists, there may be a need in the future to tailor these to the different needs of different doctors. “Learning in the area of professionalism is an especially important focus,” the review states.

Education Update, The risk of working with others

Dr Mark O’Brien looks at reducing risk from professional interactions

While poor patient communication has long been established as a major risk factor for complaints or claims, Dr Priya Singh, Executive Director, Professional Services, MPS, notes: “It is important members know that ensuring high quality verbal and written communication between doctors has been identified by MPS as an important strategy to reduce the risk of patient harm and action against members.&rsquo

Disagreements between clinicians are common and poor communication between doctors in this situation can contribute to patients believing they’ve received poor care

MPS has increasingly identified communication between doctors as a significant source of risk in two critical areas.

Referrals and handovers

Patient care is often passed between doctors, whether in the form of a referral or a handover. In these instances, poor communication can lead to:

Abnormal investigations not acted on
Wrong diagnosis made or wrong investigation and treatment undertaken
High risk treatments not effectively monitored
Predictable complications not recognised
Significant co-morbidities not taken into account
Unnecessary investigation and treatment.

Disagreements between colleagues

Disagreements between clinicians are common and poor communication between doctors in this situation can contribute to patients believing they’ve received poor care. Hickson found doctors urging patients to sue was a factor in one third of litigation cases.¹

Helping you to reduce your exposure to these risks

These challenging situations are explored in MPS’s Mastering Professional Interactions workshop. This half-day workshop is offered free of charge to members, as a benefit of membership.

Mastering Professional Interactions is run in Ireland. For more information, including forthcoming dates, locations and online booking, please visit:www.medicalprotection.org/ireland/workshops.

Further information

Hickson GB et al, Obstetricians’ Prior Malpractice Experience and Patients’ Satisfaction with Care, JAMA 272: 1583-1587 (1994).

On deadly ground »