Section 5Complaints
A catalogue of complaints MDU advice
A 40-year-old woman attended her GP to discuss The MDU adviser and the GP discussed responding to the
contraception. She revealed her periods were complaint following the new combined NHS and social
heavy and had been for many years. She had one care complaints procedure, which came into effect on
child. She was not keen to take oral hormonal April 1
st
2009. The GP was reminded that the practice
contraception and the GP discussed various should offer to discuss with the patient an agreed
alternatives, including the intra-uterine approach to investigating the complaint, including
progestogen-only device. The patient returned two expected timescales. The response should include an
weeks later for insertion of the intra-uterine explanation of how the complaint was investigated; the
system (IUS) and was shown into the treatment conclusions reached, learning points that had emerged
room. The GP fitted the IUS and arranged a and remedial action to be taken, if any; and advice that
six-week follow up appointment. the patient has a right to take the matter to the
The patient called the practice four days later and spoke
Ombudsman within 12 months of the date of the
to a receptionist who left a message for the GP on the
concerns being first noticed if dissatisfied.
electronic messaging system indicating that the patient The GP in his letter to the MDU stated:
complained of pain and heavy bleeding. The GP called
the patient and entered a note stating “advice given”.
• it was his usual practice to caution patients about risk
of uterine perforation, though he had not
The patient saw the practice nurse two weeks later for documented this in the records;
an unrelated problem but mentioned she could not feel
the IUS threads. This was noted in the record.
• he had given information to the patient about pain
during the procedure but recalled it was a difficult
At the six-week review the GP examined the patient and insertion, and he had not fully appreciated until then
could not detect the threads when using a thread that the patient’s child had been delivered by
retriever. An ultrasound was arranged which revealed caesarean section;
the IUS was in the abdominal cavity. A laparascopy was
required to retrieve the IUS.
• although the patient had not had a vaginal delivery
before, this was not a contraindication to the IUS but
The patient made a written complaint alleging that: the GP felt he could have discussed the use of
• insertion was unexpectedly painful and she had been
additional pain relief during the procedure, for
told by the gynaecologist it was inappropriate as she
example a local anaesthetic gel;
had not had a vaginal delivery; • he was sure that the patient had not mentioned the
• she was given inadequate advice about pain relief
missing threads during the subsequent telephone
and bleeding;
conversation, as he would have followed this up, but
acknowledged that his note was very brief.
• she was not warned about risk of perforation;
The MDU adviser suggested the GP check with the nurse
• the receptionist had made too intimate an enquiry about the ‘missing threads’ note and she accepted that
about her symptoms when she telephoned to speak she should have sought advice from a GP when this was
to a GP; and mentioned.
• she had told the GP during the telephone call that The GP conducted a significant event audit, which included
she could not feel the threads, and again when she a review of the receptionists’ protocol for taking
had seen the nurse, but nothing was done until the messages, issues about seeking and documenting
six-week review. consent, and advice given to patients, including
appropriate pain relief and telephone advice. An advice
The GP, an MDU member, contacted the MDU for help
leaflet had been produced for future use. The GP was
with a response to the complaint.
advised to include aspects of this review in his response.
The GP provided a written response including an
explanation and apology. He also met the patient.
“…discuss with the patient an
During the meeting the GP said he was sorry for any
breakdowns in communication and for the pain she had
agreed approach to investigating
experienced during the insertion and afterwards. He
the complaint...”
explained how the practice had changed its procedures
following the significant event audit.
The patient accepted that the perforation was a
recognised risk of the procedure though still felt it could
have been picked up at an earlier stage. Overall, she
accepted that the practice had looked at the various
issues involved and the complaint was resolved.
31
Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74