CONTENTS IN THIS ISSUE


NOVEMBER of last year saw the launch of a 670-page white paper setting out a “blue print” for an independent Scotland. This signalled the kick-off of what is promised to be an intense period of campaigning in the run-up to the September referendum. The implications of a Yes vote for the practice of medicine and dentistry in the UK are varied and complex. How will healthcare professionals be regulated in an independent Scotland and what role would the current GMC/ GDC retain if any? What about cross border working and medical and dental education and the current role of the royal colleges in setting standards? Would an independent Scotland continue to attract the same level of research funding? And what about current NHS pension arrangements? It is fair to say the devolved healthcare system in Scotland


has not so much diverged as held a steady course in contrast to the top-down radical shakeup that NHS England has seen over the last few years. But independence is, of course, a


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Cover image: Untitled by Susie Wilson 1991. Medium: lithograph.


Susie’s work is in the collection of the City Art Centre, Edinburgh Fine


Art Library and Edinburgh College of Art.


Art in Healthcare (formerly Paintings in Hospitals Scotland) works with hospitals and healthcare communities across Scotland to encourage patients, visitors and staff to enjoy and engage with the visual arts. For more information visit www.artinhealthcare.org.uk, Scottish Charity No: SC 036222. Photograph: Ros Gaunt.


WINTER 2014


whole new ball game. One page 10 of this issue we put some of the issues to representatives on both sides in the debate. On page 12 Allan Gaw tells the fascinating story of the thalidomide scandal and how medicine, the profi t motive and even popular culture intersected in the playing out of this medical tragedy. It’s also the story of how one woman’s determination may have prevented even greater suff ering. Are dentists wise to treat friends and family members? Dental adviser Doug Hamilton looks at the risks on page 18 while Deborah Bowman considers the ethics of becoming involved in the personal lives of patients on page 9. Is it more a matter of discretion than uncompromising rules? And on page 16 Professor Charles Warlow highlights some


of the common pitfalls in the early diagnosis and management of stroke.


Jim Killgore, editor


SAVING MARILYN Clinical researcher and writer


Dr Allan Gaw evokes the story of Marilyn Monroe’s death in a cau- tionary tale of the risks of allowing commercial considerations to trump patient safety in drug development


THE RIGHT RESPONSE Ian Reeves of the Scottish


Public Services Ombudsman dis- cusses the reasons behind patient complaints and the importance of an eff ective response


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CLINICAL RISK REDUCTION Professor Charles Warlow highlights some common pitfalls in the early diagnosis of stroke


Editor:


Jim Killgore Associate editor: Joanne Curran


Editorial departments: MEDICAL Mr Jim Rodger DENTAL Mr Aubrey Craig LEGAL Simon Dinnick RISK Peter Johnson


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A FRIEND IN NEED? Do the same rules for doctors


treating family and friends apply to dentists? MDDUS dental adviser Doug Hamilton urges caution


REGULARS 4 Notice Board 6 News Digest


8 Risk: Incidentally speaking 9 Ethics: Getting personal 10 Scottish independence: The health debate 20 Case studies: Haematuria noted, Tooth beyond saving, Call recordings 22 Addenda: Only a misadventure, Thumb sucking guards, Crossword and Vignette: Edith Clara


Summerskill, GP and political activist


Please address correspondence to:


Summons Editor MDDUS Mackintosh House 120 Blythswood Street Glasgow G2 4EA


jkillgore@mddus.com


Design and production: CMYK Design 0131 556 2220 www.cmyk-design.co.uk


Printing and distribution: L&S Litho


Summons is published quarterly by The Medical and Dental Defence Union of Scotland, registered in Scotland No 5093 at Mackintosh House, 120 Blythswood Street, Glasgow G2 4EA. • Tel: 0845 270 2034 • Fax: 0141 228 1208


Email: General: info@mddus.com • Membership services: membership@mddus.com • Marketing: marketing@mddus.com • Website: www.mddus.com The MDDUS is not an insurance company. All the benefi ts of membership of MDDUS are discretionary as set out in the Memorandum and Articles of Association.


The opinions, beliefs and viewpoints expressed by the various authors in Summons are those of the authors alone and do not necessarily refl ect the opinions or policies of The Medical and Dental Defence Union of Scotland.


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