CONTENTS FROM THE EDITOR
REALISTIC Medicine, the recently published annual report from the chief medical officer (CMO) in
Scotland, poses interesting questions about the future direction of medical practice. It touches on several key medico-legal issues including the potential harms of overtreatment, guidelines and their limitations, the changing nature of the consent process and the management of clinical risk. The reference to evidence showing that doctors generally choose less treatment for themselves than they provide for their patients is particularly thought provoking. On page 10, Dr Catherine Calderwood talks to Joanne Curran about the report and her role as CMO. Pulmonary embolism is a relatively common life-threatening condition which can be difficult to diagnose and thus poses a significant challenge to doctors. David Riding and Charles McCollum provide a helpful summary of the diagnosis and
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16 SUMMONS SUMMER 2016 AN PUBLICATION FOR MEMBERS
Cover image: Sunset Gullane Bay, John Houston. Woodcut, 1992.
• Realistic medicine • Leaving well• Nuremberg legacy •
Fife-born John Houston studied at Edinburgh College of Art from 1948-54, and went on to teach there until 1989. He was married to artist Elizabeth Blackadder.
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.
SUMMER 2016
management of the condition on page 16. MDDUS dental adviser Doug Hamilton considers the
implications of a landmark legal ruling on informed consent and what constitutes relevant risk in shared decision making (p. 18), and risk adviser Alan Frame delves into a recent ombudsman report on complaints handling and draws some important lessons on the importance of a sincere apology when patient care does not go to plan (p. 14). On page 12, Allan Gaw recounts an important milestone in modern human research ethics that emerged out of the Nazi war crimes trials in 1947 – though the Nuremberg Code was largely ignored for 20 years after its publication. And on page 9, Deborah Bowman considers ethical
obligations when changing jobs and what it means to “leave well” – the trigger being her own impending career move.
Dr Barry Parker
BEING REALISTIC FOR PATIENTS
Scotland’s CMO Dr Catherine Calderwood discusses her ambitious plans for a common sense, patient- focused approach to healthcare
NEVER AGAIN Allan Gaw recounts the origin
of The Nuremberg Code on human research and its enduring relevance
FOR WANT OF AN APOLOGY Risk adviser Alan Frame looks
at how a considered apology can often defuse fraught face-to-face encounters in complaint handling
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CLINICAL RISK REDUCTION: PULMONARY EMBOLISM
A low threshold of suspicion is advised for this common and often fatal condition
Editor:
Dr Barry Parker Managing editor: Jim Killgore Associate editor: Joanne Curran Editorial departments: MEDICAL Dr Richard Brittain DENTAL Mr Aubrey Craig LEGAL Simon Dinnick
REGULARS 4 Notice Board
6 News Digest 8 Risk: Age of consent 9 Ethics: On leaving well 20 Case studies: Tubal pregnancy, Reasonable treatment goal, A high smile 22 Addenda: Object obscura: Pomander, Book review – When breath becomes air, Crossword and Vignette – Sir Victor Horsley, neurosurgeon and polymath
Please address correspondence to:
Summons Editor MDDUS Mackintosh House 120 Blythswood Street Glasgow G2 4EA
jkillgore@mddus.com
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:
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www.mddus.com The MDDUS is not an insurance company. All the benefits of membership of MDDUS are discretionary as set out in the 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 reflect the opinions or policies of The Medical and Dental Defence Union of Scotland.
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SEA CHANGE IN CONSENT Dental adviser Doug Hamilton
tests the waters after a landmark legal ruling on shared decision making in consent
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