CASE studies
These studies are summarised versions of 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
TREATMENT: A BLEAK OUTLOOK
BACKGROUND: Mr M visits his GP, Dr C, complaining of difficulty sleeping and anxiety which is exacerbated by painful swelling on his face. The 61-year-old, who has a recent history of insomnia, heart problems and various minor medical complaints, is diagnosed with suspected facial cellulitis. Dr C prescribes medication for the cellulitis and further medication for his insomnia and anxiety. Mr M consults with another doctor at the practice on several occasions over the following two months, continuing to complain of insomnia, anxiety and occasional tightness in his chest. In addition to the strain of recovering from cellulitis, he highlights a number of stressful personal issues he is struggling with and fears he is at risk of a heart attack. The GP prescribes beta blockers and antidepressants and reassures the patient there are no other issues of concern. The doctor also discusses using a self-help guide to reduce anxiety. On two occasions the GP adjusts Mr M’s medication dosage in response to reports of minor side effects and later diagnoses him with depression. He switches the patient to a different antidepressant and a different drug for insomnia. Four months after their initial consultation, Mr M returns to Dr C. He is still feeling anxious and finds it difficult to concentrate, but there is a slight improvement in his sleeping patterns. Dr C makes no changes to the patient’s medication and advises him that the insomnia and anxiety could potentially continue for up to two years, but there should be improvement if his personal issues can be resolved. One week later the practice is
informed that Mr M has committed suicide. His widow complains to the practice about the treatment he received in the months before his death. In particular, she questions whether his prescription medication and the bleak prognosis delivered by Dr C increased his risk of suicide.
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Following a practice significant event review, Dr C writes to Mrs M apologising for the manner in which he gave Mr M’s prognosis and offering his sympathies over the patient’s death. An investigation carried out by a local health authority suggests the clinical treatment provided was appropriate but Mrs M is not satisfied and complains to the General Medical Council.
ANALYSIS/OUTCOME: Dr C informs MDDUS he is one of two doctors at the practice being investigated by the GMC following the patient’s death and a medico-legal adviser helps him prepare a response. An independent expert report commissioned by the
regulator into Dr C’s handling of the patient’s care is supportive of his clinical decision making, describing it as “adequate and appropriate”. It states there was no indication for Dr C to obtain a more detailed medical history or for him to arrange or conduct any further tests or investigations in the consultations leading up to the patient’s death. The report supports the GP’s actions in prescribing and reviewing Mr M’s medication. The expert adds that there was no indication that Dr C did not adequately inform Mr M about potential medication side effects and that it was “quite appropriate” for the GP to advise that his anxiety and insomnia could persist for up to two years. Based on the evidence
provided, the GMC concludes the case with no further action.
KEY POINTS •
Be conscious of a patient’s state of mind/ mental health, particularly when delivering bad news or a bleak prognosis.
•
Fully discuss treatment options, potential risks and side effects – tailored to individual patient circumstances.
SUMMONS
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