16
On the case W
Dr Ming-Keng Teoh, Head of Medical Services (Asia), introduces this issue’s round- up of case reports, many of which highlight the importance of working with others.
orking effectively with others to ensure patient safety involves thorough handovers,
careful delegation and a willingness to revisit colleagues’ decisions or diagnoses, where appropriate. “Minor operation – major problem” on page 17 shows how important it is that when delegating, you must be satisfied that the other doctor has the experience, skills and knowledge needed to provide good clinical care. Similarly, if a task has been delegated to you and you feel concerned about the appropriateness of the treatment, as Dr Q did in this case, you should raise this with your senior colleagues before proceeding – and document this. Challenging a colleague’s diagnosis or treatment plan can be daunting, particularly for junior doctors. Our Asian preference for harmony and deference to seniors can make this a little difficult. However, it is imperative to do so if you feel patient care may be compromised. Your ability to point out a senior colleague’s mistake in a sensitive and tactful manner can make a good impression and result in trust building. Poorly-managed delegation can
CASE REPORT INDEX PAGE TITLE 17 18 19 20 21 22 23
The clue is in the water The returning traveller Right level, wrong site Mother knows best An age-old problem
lead to adverse outcomes not only when performing clinical procedures, but when taking informed consent. In “Jotting it all down” on page 18, expert opinion did not find Mr Y negligent as a result of Mrs T’s ureteric injury during the hysterectomy, but he was found liable for failing to warn Mrs T of the potential complications involved. Taking consent was delegated to a junior who did not have sufficient knowledge of the procedure. Mrs T was not warned of the possibility of postoperative loin pain and so did not report it straight away, leading to further complications. Although you may not be accountable for the decisions and actions of those to whom you delegate, you are still responsible for the overall management of the patient and accountable for your decision to delegate. Sometimes, it is important to refer
upwards; in “Mother knows best” on page 22, Dr Y did not refer baby T to a senior colleague, despite the mother and baby re-presenting at the Emergency Department (ED) shortly after discharge, and the receptionist in “An age-old problem” (page 23) did not
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.
approach the doctors in the surgery for advice because they were busy. Doctors need to be aware of their own limitations, but also need to ensure that all staff are aware of their individual role and limitations.
SPECIALTY
Minor operation – major problem Jotting it all down
HAND SURGERY GYNAECOLOGY
GENERAL PRACTICE GENERAL PRACTICE NEUROSURGERY PAEDIATRICS
GENERAL PRACTICE
SUBJECT AREA CONSENT CONSENT DIAGNOSIS
INVESTIGATIONS/DIAGNOSIS
INTERVENTION AND MANAGEMENT/CONSENT/COMMUNICATION DIAGNOSIS/INVESTIGATIONS SYSTEM ERRORS
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 US$2,000,000+ Substantial US$200,000+ Moderate US$20,000+ Low US$2,000+
Negligible <US$2,000
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