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Over to you…


Fatal inaction The case report “Fatal inaction” (Casebook 18(3)) stimulated considerable correspondence, with wide-ranging views on possible interpretations of the clinical details. The focus of Casebook case reports is always on the learning points, which are taken from a medicolegal – rather than clinical – perspective. Clinical details are purposefully kept to a minimum and further changes to this detail are made to ensure full anonymity. Many thanks to all those who took the time to contact us regarding this case report.


Support for the MPS way This letter was received in response to a covering letter from MPS Chief Executive, Tony Mason, which accompanied Casebook 18(3). I’M RESPONDING TO your request for feedback in your recent letter to members – your news was a detailed yet succinct summary of the MPS position on “Discretion and Occurrence Cover”. I’m an intensivist/


anaesthetist, an associate postgraduate medical dean in the East Midlands and in my middle 50s. My wife is also a consultant anaesthetist and a similar age to me. For many years I took my indemnity with another company as a result of an un-researched spontaneous decision as a medical student. Then, many years later, I was enlightened by my wife that I should swap to MPS. I would like to offer our


strongest support for the position you represented


on behalf of MPS and its members in your letter. All of our efforts – whatever the detail of our daily endeavours and whatever our role in the health service or in supporting those in the health service – should always be aimed at promoting patent safety and patient wellbeing. The position MPS has taken for nearly 120 years is a great, if somewhat oblique, example of this principle. Charlie Cooper, Nottingham, UK


We welcome all contributions to Over to you. We reserve the right to edit submissions. Please address correspondence to: Casebook, MPS, Granary Wharf House, Leeds LS11 5PY, UK Email: casebook@mps.org.uk


then suddenly you have no leg to stand on. I am saddened by cases where a doctor just tried to help out of the goodness of his heart and then gets sued or told he was acting outside the sphere of his competence – for example, Dr Q in the case report “Fatal inaction”. If Dr Q would have done, or said, nothing (or if he would have said “Sorry, this is outside my competence, I cannot give any advice or help”) what would the


that fewer doctors’ children want to become doctors? I think most doctors really try their best, bending over backwards to help a patient – I am just thinking of the average GP in South Africa and the vast amount that he/she does every day. And I am not complaining, I love what I do. It’s just sometimes that I think that the world should treat their doctors with a bit more grace. Dr Martin Cramer, South Africa


An evolving situation I READ WITH INTEREST your case report (“An evolving situation”) regarding bilateral subdural haematomas, missed repeatedly in a patient attending an ED (Casebook 18 (3)). I have empathy with the junior doctors involved in the case, given that the patients' initial head CT was normal. I am pleased to hear Mr M made a full recovery. May I suggest two additions to the learning points you highlight:


1. Always discuss patients re-attending with the same complaint with the duty ED consultant. Most EDs with whom I am familiar have this as a rule, for evident risk management purposes.


2. Always reconsider your clinical reasoning before issuing any ED patient with a diagnosis of “viral gastroenteritis”. In the case of Mr M, where was the evidence of any “enteritis”?


Gavin Lloyd, Consultant Emergency Physician, Royal Devon and Exeter Hospital, UK


Great expectations THANK YOU ONCE again for an interesting Casebook issue. I read every magazine with keen interest. But I must say that after reading every issue, although it motivates me to be continuously on my toes, I wonder sometimes if it would not be better for me to go fishing instead of being a doctor. I have read of so many cases in Casebook articles that could have happened to me. I am not talking of pure negligence or just bad doctoring, but just here or there a small symptom or sign overlooked, or “you have checked but not written down in detail” and


response have been then? I see many doctors get sued or many litigation cases, where plenty of doctors were consulted by one patient for the same problem. For example, Dr A on Monday, Dr B on Wednesday, Dr C on Friday, etc. In my opinion, I still think it is best if one doctor takes responsibility for his patients and keeps on seeing them regularly. I wonder sometimes what patients expect from a doctor. We cannot guarantee a fault free or problem free outcome – for example, in your case report “A recognised complication”. Could this be the reason


Fit for purpose? Please note that this letter refers to an article that appeared in the UK edition of Casebook only – you can read it online here: www.medicalprotection.org/ uk/casebook-september-2010/ fit-notes-fit-for-purpose THE ISSUE OF “fit notes” saddens me that GPs appear to be the focus for missives and imposition of training because we are assumed to be the cause of the system failing. I have worked in the New Zealand ARCIC system, which is similar to the idea behind the changes here, but it worked well. I believe British GPs do


OVER TO YOU


UNITED KINGDOM CASEBOOK | VOLUME 19 | ISSUE 1 | JANUARY 2011 www.mps.org.uk


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