Dr Pallavi Bradshaw, MPS medicolegal adviser and spokesperson. She advises and supports healthcare professionals predominantly in the UK and Asia, and has a specialist interest in emerging matters. Dr Bradshaw has had articles placed in leading medical trade publications on a number of legal and ethical issues. Here, she discusses the unique risks that can come with treating patients at Christmas time
Christmas may be a time for giving and sharing but it is also synonymous with decadence and over indulgence. When spirits are high and the clock ticks towards the holidays it is important that doctors do not let the Christmas cheer get the better of their clinical judgment. Whilst in clinical practice ‘common things are common’, unfortunately the same is also true for medicolegal problems. I’ve worked through a few Christmases, which got me thinking about calls I’ve had in the past on the MPS advice line and issues I’ve seen as a doctor…
MPS deals with a number of claims of misdiagnosis such as heart attack, stroke, appendicitis, and issues related to prescribing errors. It occurred to me that the festive period is a time when signs and symptoms can masquerade and be dismissed as being a relatively harmless ‘seasonal related illness’. These issues can be compounded by doctors seeing patients out of hours without the benefit of access to medical records, patients visiting family or dealing with vulnerable patients such as the elderly and children.
We all overeat and drink too much on and around Christmas day. I am sure that the sale of antacids and indigestion tablets peak over the festive and New Year period. For most the discomfort is short lived and treated easily but for others, a trip to the doctor is needed for pain relief or reassurance. Whereas the majority will settle, doctors need to be mindful of common symptoms that could indicate a more serious problem presenting atypically, like chest pain. High risk patients in particular should be provided with the same investigations for chest pain even though heartburn may be the most obvious diagnosis.
Patients of different ages may present with what you suspect to be drink related problems such as sickness and dizziness – generally seeming to be in the aftermath of being hungover. But again it is important not to take the symptoms on face value. A patient who is unsteady and has nystagmus may well have had too much to drink at the office party but they could also have a completely unrelated neurological condition which has presented coincidentally.
The hungover teenager who can’t stop throwing up may on questioning admit to a longer history of tiredness and sickness and could in fact be pregnant. Simple observations and direct questioning can aid the diagnosis of a more serious problem and although departments and practices are over-loaded with work at this time, corners shouldn’t be cut.
"If you see a temporary patient you should consider taking steps to contact their normal GP for information especially if medication needs to be prescribed or if you think they might need to be referred for further treatment"
Diabetics are at particular risk of problems with erratic eating and excessive drinking. They are a particularly vulnerable group, as are children, and ensuring hydration from something like a turkey-related food poisoning can be a difficult task. Differentiating the ‘usual’ culprit from the true cause of the child’s tender abdomen is also important as delayed diagnosis of appendicitis can lead to problems not only for the child, but the doctor too.
Prescribing medication can be a minefield when patients present to a doctor they have never seen before. This occurs when the patient presents as an emergency, either because they live out of the area or because their regular GP is on leave. Taking a thorough history and reviewing any records held is vital. If you see a temporary patient you should consider taking steps to contact their normal GP for information especially if medication needs to be prescribed or if you think they might need to be referred for further treatment.
Where possible, information should also be given to the patient to take back with them in case symptoms continue or worsen. Second guessing what medications someone is taking if they have run out, based solely on their description, can be tempting but should be avoided. Advice should usually be to seek medical assistance as soon as possible with usual safety netting.
Finally, even though Christmas is about family and goodwill it is unfortunately a time of year when vulnerable people can feel even more isolated. Suicide, relationship problems and hypothermia cases typically increase over these few months and practices may consider what support can be provided especially to the elderly and those on the poverty line. Social services could be involved and information regarding charities and crisis teams can make a huge difference and could be publicised within practices in the run-up to the festivities.
Well – to those working over the Christmas period, I hope it isn’t too busy and remember that simpler cases may not be as straightforward as they seem.