Case report: Case closed after a pause for reflection

This case is based on a real scenario, with some facts altered to preserve confidentiality.

______

Dr P, a haematology SAS doctor contacted Medical Protection following a complaint made by a patient, with a reported referral to the GMC. The complaint related to elements of care that had occurred over a series of clinic appointments.

The patient had been diagnosed with follicular lymphoma identified through a lymph node biopsy. The patient had no B symptoms and was systemically well. Dr P spoke with the patient initially in clinic to explain the diagnosis and plan some further investigations including a PET scan.

Unfortunately, when Dr P saw the patient again in clinic to discuss the scan results, the scan had not taken place. The patient was angry that he had returned to clinic, when he thought he was having the scan that day. Dr P apologised and noted that although he had written the scan as part of the plan, it had not been ordered. An apology was made to the patient, and a scan was ordered. The patient returned for follow-up but requested to see the consultant.

While Dr P thought the initial consultation had gone well, the patient subsequently complained that Dr P was dismissive of his concerns about potential treatment options at the first appointment and had not explained the steps to obtain valid consent. The patient had understood that he had stage 2 lymphoma at the time but was later told this was stage 4. In addition, he expressed concern about the failure to arrange the PET scan. The patient wrote to PALS complaining about his care and advised that he had also approached the GMC with his concerns.

Dr P contacted Medical Protection when he received the complaint and requested support with responding. He had not heard from the GMC.

Dr P acknowledged that the clinic appointments had been challenging as he felt the patient had been reluctant to listen to the investigation plan and was jumping ahead by talking about treatment before the staging had occurred.

Dr P drafted a complaint response addressing the factual concerns raised by the patient, however felt he did not need to provide reflections in his response as the patient had been challenging.

After discussing the case and proposed response with a medicolegal consultant at Medical Protection and his clinical lead, Dr P undertook CPD, having been informally advised by the Trust that colleagues felt he was not always clear when explaining treatment options. He undertook modules in consent, learning from outcomes and adverse outcomes. He also went on a communication skills course, following advice from his clinical lead.

Dr P made it clear to the patient that he was planning on undertaking the training to demonstrate that he had taken the feedback seriously and was seeking to improve his practice. The patient accepted the complaint response and the apology within the response.

The GMC wrote to Dr P during the complaint process, to advise that they had received concerns and would be undertaking a provisional enquiry (PE). Dr P had already received information on this process from the  medicolegal consultant assigned to his case and continued to attend the planned educational courses. He also and provided reflections to Medical Protection and his clinical lead on these courses as part of his ongoing development. The GMC closed the PE within five weeks.