13


On the case


Dr Rob Hendry, Deputy Medical Director, introduces this issue’s round-up of case reports, which highlight the importance of being aware of distracting symptoms, and being prepared to revisit decisions, when making a diagnosis


n “Too quick to clear the spine” on page 14, the multiple injuries Miss T suffered in a road traffic accident made it difficult to localise the pain to her neck. As a result of these distracting injuries, ED consultant Dr W missed the C6 fracture and removed Miss T’s spinal collar. A detailed record of the severity of the accident might have alerted Dr W to the potential for severe spinal injury. In this case, the two junior orthopaedic doctors did not challenge Dr W’s diagnosis that Miss T’s c-spine had been cleared, despite the paraesthesia in all her limbs. Where necessary, previous clinical decisions should be challenged, even those of senior colleagues. Similarly, you should always be


I


prepared to revisit your own diagnosis, should symptoms persist. Dr G, in


“Double problem, double risk” on page 20, was distracted by Mr E’s multiple complaints and did not reconsider his initial diagnosis. The five-month delay in the diagnosis of squamous cell carcinoma of the tonsil meant that the case could not be defended. In “Too


CASE REPORT INDEX PAGE TITLE 14 15 16 17 18 19 20 21 22 23


many records spoil the notes” on page 15, ophthalmology consultant Mrs C failed to diagnose Mr M’s glaucoma, despite there being recurrent abnormalities in his vision and a family history of glaucoma. Listening to the patient is imperative; have an open, unbiased mind at each consultation and consider a second opinion if you are unable to account for a patient’s symptoms or clinical signs. Inaccurate record-keeping and retrospective amendments to the patient’s records made this case indefensible. Conversely, accurate record-keeping can help to build a successful defence against a claim. We often receive feedback from members asking us to feature more successfully defended case reports; “Right patient, wrong sample” on page 17 and “More than a bruise” on page 18 are such examples. In “More than a bruise”, none of the doctors involved were found to be in breach of their duties, despite Mr U’s sudden and unexpected death. Records clearly showed the careful management of his condition, examination and


SPECIALTY Too quick to clear the spine


Too many records spoil the notes OPHTHALMOLOGY Ignoring the cold foot


PAEDIATRICS


Right patient – wrong sample More than a bruise


“Just a quick look” can be costly Double problem, double risk An unfortunate prescription Symptoms that don’t add up Your patient, your responsibility


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. Unless otherwise stated, facts have been altered to preserve confidentiality.


documentation of symptoms. Had the records not been comprehensive, there could have been reasonable doubt that there were missed symptoms or signs.


SUBJECT AREA


EMERGENCY MEDICINE AND ICU ORTHOPAEDICS DIAGNOSIS/INVESTIGATIONS DIAGNOSIS/RECORD-KEEPING


INTERVENTION AND MANAGEMENT/RECORD-KEEPING


HISTOPATHOLOGY AND GASTROENTEROLOGY SUCCESSFUL DEFENCE GENERAL PRACTICE/EMERGENCY MEDICINE


SUCCESSFUL DEFENCE


VASCULAR SURGERY/ORTHOPAEDIC SURGERY DIAGNOSIS/INVESTIGATIONS GENERAL PRACTICE/ENT GENERAL PRACTICE GENERAL PRACTICE OBS&GYNAE


DIAGNOSIS


NOTEKEEPING/PRESCRIBING DIAGNOSIS


NOTEKEEPING/INTERVENTION AND MANAGEMENT


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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