4 Ask the experts
MPS medicolegal adviser Dr Sarah Townley answers common medicolegal queries from sessional GPs
A 17-year-old female patient rang the out-of-hours (OOH) centre complaining that she had recurrent symptoms of a chest infection. A treatment centre visit was arranged, the diagnosis was confirmed by a GP and the patient was prescribed amoxicillin. Unfortunately, the patient was allergic to penicillin and had an anaphylactic reaction
requiring hospital treatment. The initial call to the OOH centre was recorded by the triage nurse and the patient volunteered the information that she was allergic to penicillin. In addition, the patient was clear that she told the GP that she was allergic to penicillin – an allergy history was not recorded in the OOH record. MPS member
One of the main difficulties of OOH sessional work is the lack of access to patient medical records. It is essential to remember that histories taken from patients seen in an OOH setting may need to include details that aren’t routine in a normal GP consultation. Adverse reactions to medicines are particularly important as an alert will not routinely flash up if the information has not been previously recorded. In Good Practice in Prescribing Medicines, the GMC advises that you should be in possession of an adequate history from the patient, including any previous adverse reactions to medicines, current medical conditions, and concurrent or recent use of medicines, including non-prescription medicines, in order to
prescribe responsibly. This case also highlights
the importance of reviewing all the OOH notes, including the triage notes, as they may hold essential information, particularly in the cases of patients who may struggle to give adequate information. In this case, a claim ensued and the GP was adamant that they had asked the patient about any allergies and none were reported. However, given that
no allergy history was recorded, together with the fact that the patient volunteered the information to the triage nurse, the GP accepted that the best way forward was to resolve the claim by way of an early negotiated settlement.
I’ve started working in a new practice. Recently, one of the partners mentioned that she’d been given an expensive necklace by a patient, whom she has been treating for six months for a psychiatric illness. I’m not sure what to do with this information. MPS member
Accepting gifts from patients has both ethical and contractual considerations. Contractually, individual GPs and contractors must keep a register of gifts from patients that have a value of over £100. The PCT can request to see such registers. The register should record the name of the donor, nature of the gift and its approximate value. GPs should also consider whether they need to take financial advice regarding the tax implications of such gifts. The GMC advises on the ethical considerations, stating: “You must not encourage patients to give, lend
or bequeath money or gifts that will directly or indirectly benefit you.” Essentially, you must remain transparent and accountable when receiving gifts from patients. In this case, it is imperative to gain further information from
the partner regarding the gift received and then perhaps offer helpful advice regarding a gift register within the practice. If you are concerned after this that there may be
potential exploitation of a vulnerable patient, then it would be reasonable to raise the matter with a senior partner within the practice or, failing this, with the PCT.
MEDICOLEGAL FEATURE
SESSIONAL GP | VOLUME 3 | ISSUE 2 | 2011 | UNITED KINGDOM
www.mps.org.uk
KUTAY TANIR/
ISTOCKPHOTO.COM
IZABELA HABUR/
ISTOCKPHOTO.COM
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