7 Useful links


■■ MPS factsheets, Unscheduled care for health professionals – www.medicalprotection.org/uk/uk- factsheets/unscheduled-care-for-health-professionals


request”, Dr Dunn was confronted by Mrs Coates who was seeking a visit for her daughter Jennifer, and fell into the trap of entering into a dispute about the OOH visiting policy. In circumstances where a patient is complaining of abdominal pain, it is almost inevitable that a doctor will be criticised if they have not undertaken an abdominal examination, hence if a patient is particularly insistent on a visit and


there are reasonable reasons why they may not be able to attend, then the safest approach is to undertake the visit.


Record-keeping Comprehensive record- keeping is fundamentally important in general practice; however, in OOH it is particularly important for the following reasons. ■■ You are particularly vulnerable to complaints and claims in OOH


and your records will form the basis for your defence should your practice be criticised.


■ ■ Your records are not only important for you, but for others who may be involved in a patient’s care. In the OOH setting it is much more likely that your records will be viewed by a colleague who has no previous knowledge of the patient, and therefore it is particularly important that they accurately reflect your consultation. It is not uncommon for complaints to arise in circumstances where there have been several calls to the OOH service.


■■ A copy of your records will be forwarded to the


CASE 1: Pushing on an open door


Dr Smith was doing a Friday evening base session for his local OOH provider. She was asked to triage a call from 30-year-old Mrs Jones and note that the OOH call operator had recorded the following entry on the computer record: Patient thinks she has a urine infection and is requesting a prescription for antibiotics. Dr Smith called Mrs Jones,


who was most apologetic for calling OOH. She explained that she had been experiencing vague lower abdominal pains and slight dizziness and, for the last eight hours, she had been passing urine more frequently. Mrs Jones explained that


she had to attend her father’s 60th birthday party on the following Sunday and wanted to feel better in time for the celebrations. Mrs Jones also said that she had had a urine infection several years previously and that it had responded to Trimethoprim. Dr Smith agreed that a


urinary tract infection was the likely cause of her symptoms and arranged for a prescription to be “phoned through” to the local pharmacy that was


open late. Dr Smith advised Mrs Jones that she should see her GP after the weekend and take along a urine sample if her symptoms did not settle. Dr Smith made the following


entry in the records: Urinary frequency, low abdominal pains and dizziness. Patient thinks she has a UTI – Trimethoprim helped previously. Rx Trimethoprim 200mg bd (6) – phoned to late-opening pharmacy. Adv – r/v with own GP after w/e if symptoms do not improve (with an MSU). In the early hours of the


Saturday morning, Mrs Jones’ abdominal pains intensified and she collapsed. Mr Jones called an urgent ambulance, which took Mrs Jones to the local hospital where a diagnosis of a ruptured right tubal pregnancy was made. Mrs Jones had emergency surgery and made a good recovery.


Outcome Upon receipt of the OOH contact log, Mrs Jones’ regular GP contacted Dr Smith to update him on the unfortunate outcome. Dr Smith decided that he


would write to Mrs Jones to pass on his sympathy and apologies (and to wish her well with her ongoing recovery). Mrs Jones subsequently


wrote back thanking Dr Smith for his ongoing interest in her case and reassured him that she had no intention of making a complaint, as she had found Dr Smith to be “most friendly and helpful” when she had called.


Learning points ■■ Beware of pushing on


what appears to be an open door… it might slam back in your face.


■■ Beware of the pitfalls of telephone consultations: in this case an examination including pulse, blood pressure, abdominal assessment and urinalysis/pregnancy test may have assisted.


■■ In the context of a telephone consultation it is important to fully explore and document the history. Unfortunately, Dr Smith did not explore the possibility that Mrs Jones may be pregnant.


■■ In circumstances where a patient suspects they know


the diagnosis and the required treatment, it is important to consider other diagnoses and treatment options.


■■ If you see a fertile female with abdominal pains, ask the menstrual history.


■■ In this case, Dr Smith fell into the trap of colluding with Mrs Jones’ self-diagnosis and treatment plan.


■■ It is important to put yourself in a position to justify your management plan and, in this case, while a UTI formed part of the differential diagnosis, other potential diagnoses were not explored.


■■ Dr Smith may also be vulnerable to criticism in relation to his safety-netting, in that he did not advise Mrs Jones to seek further advice if her symptoms deteriorated over the weekend, or what red flag symptoms to look out for.


patient’s regular GP and it is important that they are made aware of the nature and outcome of the consultation. Providing general practice care in the OOH setting presents difficult challenges. However, it can be extremely rewarding and while there is a higher risk of a complaint or claim, equally it is not uncommon for patients to write with letters of thanks for treatment they have received. In order to protect yourself as an OOH GP, it is important to be aware of the pitfalls and to take all reasonable steps to minimise the perils of the twilight zone.


MEDICOLEGAL FEATURE


SESSIONAL GP | VOLUME 3 | ISSUE 2 | 2011 | UNITED KINGDOM www.mps.org.uk


TRAVELPIXPRO, PAUL LEFEVRE, AGENCYBY/ISTOCKPHOTO.COM


WEBPHOTOGRAPHEER/ISTOCKPHOTO.COM


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