CASE studies


These studies are based on actual cases from MDDUS files and are published in Summons to highlight common pitfalls and encourage proactive risk management and best practice. Details have been changed to maintain confidentiality


COMPLAINTS: A MATTER OF OPINION


BACKGROUND: A pregnant patient, Mrs D, arranges a consultation with her GP, Dr C, to discuss her preference for a home birth. She intends to ask about the risks and benefits of such a delivery compared to a hospital birth. Dr C believes it would be in Mrs D’s


best interests to give birth in a hospital setting and spends several minutes explaining the various risks associated with a home birth, highlighting the fact that the outcome for mother and baby in the event of unexpected complications can be far worse in home births. Four days later, Dr C receives a


letter of complaint from Mrs D regarding her manner and the nature of the advice offered during the consultation. The patient explains that Dr C’s insistence in arguing against a home birth left her feeling “bullied” and ill-informed and that the doctor did not offer balanced information about the options available. Mrs D’s complaint references recent research highlighting


the benefits of home birth for low-risk patients and states that Dr C did not adequately explain these. She says she felt Dr C talked down to her and was only interested in persuading her not to have a home birth. Dr C, she says, should consider changing her attitude when dealing with future patients.


ANALYSIS/OUTCOME: Dr C is surprised to receive the complaint as she believes she was acting in Mrs D’s best interests by encouraging her to have a hospital birth. Dr C contacts MDDUS for advice and a medical adviser helps her draft a response. In her response, Dr C expresses concern that Mrs D was unhappy with the consultation and goes on to explain that, based on her understanding of the relative risks and benefits, she does not support home births for any of her patients. She apologises for not noticing Mrs D’s distress during the consultation and invites her to discuss


the matter further. She closes the letter by informing the patient of her right to contact the health service ombudsman regarding the complaint. Mrs D responds by reiterating her concerns regarding Dr C’s determination to dissuade her from a home birth and, while accepting the apology, Mrs D decides to de-register from the practice. The complaint is taken no further.


KEY POINTS • When discussing issues of care with a patient it is important to provide balanced information on the various options available and to actively listen.


• Remember to take into account a patient’s treatment preferences when discussing a course of action, rather than being guided solely by your professional medical views/ experiences.


DIAGNOSIS:


BLEEDING GUMS… AGAIN


BACKGROUND: Mrs M, 48, attends her dental surgery for a routine check-up with a newly qualified associate dentist, Mr A. She complains of intermittent swollen gums and is a smoker with a history of periodontal disease. Mr A explains smoking can exacerbate gum problems and she says she plans to quit.


Mrs M attends the surgery four weeks later as an emergency


having lost a filling in UL6. Mr A places a crown but the following week Mrs M returns complaining of swollen gums, pain and bleeding localised around UL6. Mr A finds that some excess cement was left in place when the crown was fitted which might be exacerbating her pre-existing gum condition. He removes the cement, cleans the area and prescribes a chlorhexidine (CHX) mouthwash. The patient attends the practice again the following month complaining of bleeding gums. Mr A reassures her that the


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bleeding should soon settle if good oral hygiene is maintained and again advises her to quit smoking. He prescribes CHX mouthwash for five days.


ANALYSIS/OUTCOME: Three weeks later the practice receives a letter of complaint from Mrs M about the treatment given by Mr A. She says she had referred herself to the dental hospital and was diagnosed with periodontal disease as well as an abscess and evidence of cement and pus in her gums where the crown had been fitted at UL6. She was prescribed an antibiotic and told her gum disease required immediate treatment. Mrs M claims Mr A failed to diagnose and treat her


SUMMONS


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