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Video: Chain reaction

Post date: 27/11/2018 | Time to read article: 6 mins

The information within this article was correct at the time of publishing. Last updated 28/11/2018

Often, dealing with a patient’s concerns quickly can resolve a situation before a complaint is taken further. This video provides some valuable lessons in diagnosis, documentation and the information that needs to be communicated to patients.


Video transcription

[Dr. Davies] Providing advice and support forms a large part of the workload of our medico-legal advice team. Often, dealing with patient's consents quickly can help resolve a situation before a complaint is taken further. The case I'm going to tell you about now provides some valuable lessons around diagnosis, documentation, and the information that needs to be communicated to patients.

Ms. P. went to her local emergency department with wrist pain after falling off her bicycle. An x-ray was taken which appeared normal, although the radiology report recommended follow-up in case of a scaphoid fracture. The patient was sent home with analgesia and the report was sent to her GP. A couple of weeks later, the patient went to her GP complaining of ongoing pain.

The radiology report wasn't in her notes, so the GP relied on the patient's account that the x-ray was normal. The note said there was a full range of movement, but no record of any other examination. The GP changed the patient's analgesia and she went home. A few weeks later and the patient, still in pain, returned to her GP who arranged another x-ray.

This showed non-union of a fracture of the scaphoid and the patient was referred to an orthopedic hand surgeon who carried out bone grafting. The patient recovered well but wrote to her GP raising concerns about the delay in diagnosis. - [Dr. Stacey] When the member received the complaint, they contacted Medical Protection on the helpline. There are several ways you can contact Medical Protection, either by phoning the helpline, filling in an online form, sending in an email, or writing to us.

The member was particularly anxious about the complaint and spoke to a medico-legal adviser. That's a doctor with legal training. The key, first step in the management of the case is to allow the member to tell the story. That has several benefits. First of all, it's therapeutic for the member. Secondly, it helps them to consolidate their thoughts about the case.

And thirdly, it helps construct the response to the complaint. Cases of this nature generate a great deal of anxiety for members, and that's because they're conscientious and wants to do the best for the patients, and it's sometimes very difficult when things go wrong. For that reason, Medical Protection has access to a confidential counseling service which is free as a benefit of membership of Medical Protection.

And when members contact us, they're provided the details of that service that they can access if they feel a need to do so. In responding to the complaint, there are several key components that will help lead the complaint to a prompt resolution. First one is including an apology. An apology shouldn't be seen as admission of guilt.

It is one of the powerful factors that lead to resolution of a complaint. The second thing is providing the patient with an explanation as to what happened at each stage, why it happened, what the doctors were thinking. And finally, it's really important to show how the doctor and the practice have reflected on the instant, and if steps have been taken to prevent a similar occurrence in the future. It's quite reasonable to outline what steps have been taken in the context of the response.

When the practice looked into their complaint, they found the radiology report had been scanned into another patient's records by mistake. The investigation also brought to light other failings in the process for receiving x-rays, which prompted a full review and changes were put in place.

In this case, record keeping was a key feature. When a patient presents, it's very important to record the history and examination findings in the records. Another important point in relation to record keeping is to record the diagnosis, the working diagnosis, or the differential diagnosis if it's not possible to reach a diagnosis in the consultation.

It's very important to record the proposed management plan, any further investigations that have been arranged, and the information that's being provided to the patient. Also, helpful to record things like follow-up arrangements. The response included an apology and acceptance that opportunities have been missed to make the diagnosis, and that there have been failings in terms of the practice system.

[Dr. Perrott] Medical Protection offers an online learning module, the Reflections module, that will guide you through questions to help shape your personal reflections particularly around an adverse incident like this one that happened. So, we would strongly recommend that this is a good investment of your time to consider some additional training around that. So, understanding both that there is this imperative, legally, ethically, professionally to say sorry but also knowing how to actually put those words in the right way is something that clinicians can benefit from mastering.

Medical Protection can help you with processing how to say those words in our workshops. And some of our workshops, our masterclasses have professional medical actors, and they will throw horrible adverse events at you, and get you practicing those sorry words that are so important.

There are valuable learning points from this case. The obvious one is the reminder to always be suspicious of scaphoid fractures when treating wrist injuries. Symptoms should be key rather than the x-ray. But generally, this case also emphasizes it's always better to contact Medical Protection as soon as possible so that advice can be given swiftly.

Negative findings and advice given to patients should always be documented so an accurate picture of the care provided can be seen later on. Safety net should always be in place, so the patient knows what to look out for and when to come back to see you. In this case, by engaging with Medical Protection early, the practice was able to take advantage of the advice and support Medical Protection offers.

The response from the practice to the patient showed that they had taken her consent seriously and also demonstrated they're taking steps to reduce the chances of similar occurrences happening in the future. The patient who had made a good recovery was satisfied with the practice's response and didn't take her complaint any further.

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