Dr Micheal Devlin, Deputy Head of MDU advisory services, answers specific questions on some of the concerns facing doctors today.
What is the most common cause of litigation in primary care in the UK?
In the MDU's experience, the most common reasons for claims in primary care are delayed or wrong diagnosis, particularly of malignancy, and medication errors. Breakdowns in communication are also a common theme in the claims and complaints we see, for example, where the doctor has not checked whether the patient is allergic to a particular drug. We regularly produce advice for members on these areas to help them avoid the main pitfalls.
Does the quality of note keeping in primary care impact on litigation cases? How can doctors find more time to keep better quality notes without affecting the time spent with patients- this is a real problem now with pressure on appointments. In what types of consultations should a GP be particularly careful?
Breakdowns in communication are also a common theme in the claims and complaints we see, for example, where the doctor has not checked whether the patient is allergic to a particular drug
Claims may be more difficult to defend where the relevant clinical records are absent or deficient. Most importantly however, records form the basis of good communication about the patient, between doctors and with other members of the health care team, and serve as an essential reminder to the doctor at a later stage. Although this might appear to take up time that can be ill-afforded, the MDU's experience is that good notes can help to save time in the future, both for clinical and medico-legal purposes. The MDU advises that all contact with patients about their care should be accurately and legibly recorded, from consultations to telephone conversations and that notes should ideally be made at the time of treatment or as soon as possible afterwards. This is also expected by the GMC.
What situations should we involve a defence union?
Any time doctors face a medico-legal problem that arise from the normal practice of clinical medicine and need help or advice. The MDU may assist with a range of situations where a doctor's clinical care is called into question, from patient complaints and disciplinary proceedings to GMC investigations and clinical negligence claims.
What about cases of patients in nursing homes who are refusing all medication, and who don't have the capacity to understand the implications of refusal - for example, a 92-year-old in a nursing home refusing epilepsy medication. If medication was being considered to be given covertly in food, should doctors involve their defence union?
Individual doctors should contact their defence organisation to discuss their specific situation if they have concerns about the ethical or legal basis for any decision. Circumstances will vary but in general, the MDU would advise members that they have an ethical obligation to treat patients considerately and respect their dignity. Patients should be able to consent to treatment after being provided with information in a way they can understand so as to make an informed choice. This means that a competent patient may refuse treatment as well as accept it. Patients lacking capacity to decide for themselves may have appointed a personal welfare lasting power of attorney (LPA) to make such decisions. Whether or not a personal welfare LPA is appointed, no decision may be made in respect of an adult with incapacity that is not in their best interests.
Individual doctors should contact their defence organisation to discuss their specific situation if they have concerns about the ethical or legal basis for any decision
Nor can doctors give authority to nurses at the home to act in this way, as they would be accountable to their own registration body. In 2007, the Nursing and Midwifery Council issued a statement on the covert administration of medicines stating that: "Disguising medicine in the absence of informed consent may be regarded as deception...The registrant (nurse) will need to be sure that what they are doing is in the best interests of the patient/client, and be accountable for this decision."
How should doctors cope with media attention should they become involved in a high profile case? Do you provide support for this?
Each year, the MDU press office responds to nearly two hundred requests for help from members who find themselves in the media spotlight. The support we can offer includes advising doctors on how to respond if they are asked to comment about a patient; what to do if someone tries to take their photograph or doorsteps them; and, if appropriate, helping to draft a statement at the end of a case that has caught the media's interest.
What should doctors do if a patient goes direct to the GMC with a complaint rather than coming to the practice or the local PCT? Will a defence union help manage a situation like this?
We can assist members to draft initial responses to complaints and we can also support members on the rare occasions that complaints are referred to the Ombudsman
As a general principle, the MDU believes doctors should have the opportunity to respond to and resolve complaints about them at a local level. We welcome the fact that PCTs who receive a complaint about a GP are obliged to seek consent from the complainant to send details to the GP concerned so they have the opportunity to respond and we advise members to contact us as soon as they are aware that they are the subject of a complaint. We can assist members to draft initial responses to complaints and we can also support members on the rare occasions that complaints are referred to the Ombudsman.
Where the GMC receives a complaint about a doctor's fitness to practise, it will write to the doctor and we advise members to let us know as soon as they receive such a letter so we advise them how best to respond.