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Casebook Vol. 20 no. 3 -
September 2012

From the case files...

Dr Alison Metcalfe, Head of Medical Services, introduces this issue’s round-up of case reports.

Skipping over the details”, carries a warning about the dangers of falling foul of the ‘HALT’ mnemonic – Hungry, Angry, Late, Tired. Dr G was reported by his patient, and the patient’s wife, to be tired and dismissive during his consultation, and it appears that this may have played a part in Dr G failing to fully engage with his patient, Mr K, and his presentation, and falsely reassuring him. He also failed to keep an adequate note of the consultation, leaving little opportunity to resolve the factual dispute.

Poor testing and investigations were the cause of a delayed diagnosis in “Squash and a squeeze”. The failure by GP Dr V to carry out a squeeze test on the patient’s calf was considered to have led to a delay in diagnosis of an Achilles tendon rupture – a diagnosis that was only made following referral to an orthopaedic consultant.

In “Missed ectopic pregnancy”, an ectopic pregnancy was missed after a junior doctor in the emergency department, Dr Y, failed to request pregnancy tests on two occasions. Dr Y also failed to seek assistance from the on-call gynaecology team, despite the patient presenting with abdominal pains having undergone a recent termination of pregnancy.

Amid the steady stream of costly settlements in Casebook, it can be easy to forget the instances where we successfully defend our members from claims of negligence. Discovering where the doctor went right is often as valuable a learning tool as discovering where the doctor went wrong, and in “A pain in the leg”, we demonstrate the value of good record-keeping. Dr C’s failure to diagnose DVT was defended by her excellent clinical records, which revealed that she had done everything she could possibly have done.

Similarly, in “A complication, not negligence”, record-keeping again allowed us to defend our member from a claim. The allegation of bad management following the unfortunate neurological complication suffered by Baby R was refuted by comprehensive clinical notes, which clearly described the level of observation of Baby R post-surgery. The consent process was also well-documented, which showed the parents were fully aware of the potential for neurological damage.

A frozen shoulder” rounds off this issue’s case reports, showing how adverse outcomes are not always necessarily negligent.