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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.

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

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.

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.

NICE guidance watch

NICE guidance watch

Note: These anticipated publication dates are subject to change. To keep up-to-date visit www.nice.org.uk/GP or follow NICE on Twitter (@NICEComms)

September

Clinical guideline

  • Urinary incontinence

Technology appraisal

  • Lung cancer (non-small-cell, anaplastic lymphoma kinase fusion gene, previously treated) - crizotinib [ID499]

Diagnostics guidance

  • Epidermal growth factor receptor tyrosine kinase (EGFR-TK) mutation testing in adults with locally advanced or metastatic non-small-cell lung cancer
  • Gene expression profiling and expanded immunohistochemistry tests to guide the use of adjuvant chemotherapy in early breast cancer management: MammaPrint, Oncotype DX, IHC4 and Mammostrat

Quality standard

  • Atopic eczema in children
  • Depression in children and young people
  • Heavy menstrual bleeding
  • Lower urinary tract symptoms
  • Multiple pregnancy

Interventional procedures guidance

  • Insertion of endobronchial valves for lung volume reduction in emphysema
  • Photochemical corneal cross-linkage using riboflavin and ultraviolet A for keratoconus and keratectasia
  • Endoscopic bipolar radiofrequency ablation for the treatment of malignant biliary obstructions from cholangiocarcinoma or pancreatic adenocarcinoma
  • Negative pressure wound therapy for the open abdomen
October

Clinical guideline

  • Neuropathic pain – pharmacological management

Public health guidance

  • Overweight and obese children and young people – lifestyle weight management services

Technology appraisal

  • Colorectal cancer (metastatic) – aflibercept [ID514]
  • Hepatic encephalopathy (maintenance treatment) – rifaximin [ID496]
  • Vitreomacular traction – ocriplasmin [ID544]

Diagnostics guidance

  • Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel

Quality standard

  • Surgical site infection

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.”

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 locations across the UK. For more information, including forthcoming dates, locations and online booking, please visit our workshops section

Further information

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

Australia: ruling sets boundaries for duty of care

An interesting case in Australia has concluded, which raises pertinent questions over the degree to which patients should be responsible for aspects of their own care.

The case, Varipatis v Almario [2013] NSWCA 76, saw the New South Wales Court of Appeal overturn a Supreme Court decision, which found a GP who failed to re-refer a morbidly obese patient to an obesity clinic had breached his duty of care.

The claimant, Mr Almario, attended Dr Varipatis, from August 1997 to February 2011, during which time he suffered from various illnesses including morbid obesity, elevated liver function test results and liver disease. Mr Almario was told that he needed to lose weight to prevent the liver disease progressing to cirrhosis of the liver.

An interesting case in Australia has concluded, which raises pertinent questions over the degree to which patients should be responsible for aspects of their own care

Dr Varipatis referred Mr Almario to another physician, who in turn referred him to an obesity clinic. Both doctors counselled Mr Almario of the importance of losing weight – advice that Mr Almario ignored, saying he had previously lost 30kg attending the clinic which, in his opinion, had not improved his health. Mr Almario developed cirrhosis in June 2001 and liver cancer in 2011.

Mr Almario won original claim for damages, arguing that Dr Varipatis failed to take steps to treat his morbid obesity and prevent his liver cancer, and was awarded over $350,000. On appeal, this was overturned – there was overwhelming evidence by numerous doctors that Mr Almario had been advised of the need to lose weight in order to prevent further liver damage, but chose to ignore this advice.

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