16


On the case


Head of Medical Services (Edinburgh) Dr Rob Hendry introduces this issue’s ward round of case reports, which highlight the dangers in relying on decisions made by others


W


hen treating a patient who has been seen by other doctors, it is good practice to still take a


history and, if appropriate, to examine the patient again, keeping an open mind regarding alternative diagnoses. Do not presume the last doctor was


on the right track – they may not have taken a full history, or the patient’s symptoms may have changed. In


“Missed opportunities” on page 17, the doctor who performed a TOP on Miss R did not take a full history or adequately check for STIs before the procedure took place. Failure to examine the patient in this case rendered the claim indefensible. Similarly, the three different GPs who


saw Mrs S in “Cuts and bruises” on page 20 simply relied on each other’s opinion rather than seeking a new diagnosis. The GPs were criticised for failing to realise how ill Mrs S was – there was no documentation of her vital signs that could have illustrated the severity of her illness and, as such, a timely admission was not arranged. When repeat prescribing, as


in “Repeat offender” on page 21, it


CASE REPORT INDEX PAGE TITLE 17 18 19 20 21 22 23


Missed opportunities Heart of the matter


To operate or not to operate? Cuts and bruises Repeat offender


Inappropriate delegation A pain in the buttock


is important to look carefully at a colleague’s decision – do not repeat the mistakes of others. Problems can arise between primary and secondary care, when GPs take on the prescribing started by consultants. If you sign a prescription, you are ultimately responsible for it, so make sure it is correct. If a drug is unfamiliar, and you lack sufficient knowledge or experience, don’t prescribe it, until you know what you need to know to do so safely. “Inappropriate delegation” on page


22 serves as a pertinent reminder to never practise beyond your skills and expertise. This is also the case when undertaking tasks delegated by others. Junior doctors have a duty to refuse to undertake a procedure (or take consent for a procedure, as in this case) if it lies outside their field of competence, except in an emergency. Likewise, when delegating care or treatment as a senior colleague, you must be satisfied that the person to whom you are delegating has the appropriate experience, qualifications, knowledge and skills to provide the care required.


CASE REPORTS


Casebook publishes medicolegal reports as an educational aid to MPS members and to act as a risk management tool. The reports are based on issues arising in MPS cases from around the world. Facts have been altered to preserve confidentiality.


SPECIALTY


GENERAL PRACTICE GENERAL PRACTICE ORTHOPAEDICS


GENERAL PRACTICE GENERAL PRACTICE ENT


GENERAL PRACTICE


SUBJECT AREA


NOTEKEEPING/INVESTIGATIONS DIAGNOSIS


CONSENT/COMPETENCE


DIAGNOSIS/INTERVENTION AND MANAGEMENT SYSTEMS


CONSENT/COMPETENCE NOTEKEEPING


WHAT'S IT WORTH?


Since precise settlement figures can be affected by issues that are not directly relevant to the learning points of the case (such as the claimant’s job or the number of children they have) this figure can sometimes be misleading. For case reports in Casebook, we simply give a broad indication of the settlement figure, based on the following scale:


High £1,000,000+


Substantial £100,000+ Moderate £10,000+ Low £1,000+


Negligible <£1,000


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