CONTENTS FROM THE EDITOR


THERE is widespread concern that general practice in the UK has reached crisis point,


judging by the number of recent articles in the medical and lay press which have voiced alarm. And yet 85 per cent of patients in a 2016 Ipsos MORI survey described their experience in general practice as ‘good’ or ‘very good’ – it is clearly a service that the public values and trusts, and it lies at the heart of the NHS.


In this issue, Professor Maureen Baker, outgoing Chair of the


RCGP, provides her views on the challenges faced in funding, workforce planning and workload. She discusses the highs and lows of her tenure as Chair and her hopes that the new GP Forward View sets out a successful strategy to tackle the difficulties (p. 10). Acute eye presentations can be problematic for non- specialists, and consultant ophthalmologist Dr Mark Wright’s


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article on page 16 introduces the use of algorithms in order to improve diagnostic accuracy in this field. Also in this edition, medical adviser Dr Greg Dollman reviews the difficult ethical and legal position when a patient refuses treatment (p. 12). The rising cost of claims is a concern to all those involved in medical defence work, and in this issue, risk adviser Cherryl Adams reports on the types of claims that tend to be most costly (p. 8). Adam Campbell describes the inspiring and invaluable work


of the charity Changing Faces, which supports patients with disfigurement (p. 14), and Deborah Bowman presents some thought-provoking insights into the ethics of judgement (p. 9). A fearful child in the dentist chair is a situation most dentists


dread. On page 18, paediatric dentist Fiona Hogg provides some useful practical advice on dealing with dental phobia in children.


Dr Barry Parker


TAKING A FORWARD VIEW Professor Maureen Baker discusses the challenges facing general practice and the highlights of her time as Chair of the RCGP


THE RIGHT TO CHOOSE A patient refusing treatment


can present a difficult ethical dilemma. Medical adviser Dr Greg Dollman offers his insight


14 14 SUMMONS AUTUMN 2016 AN PUBLICATION FOR MEMBERS • Changing Faces • Refusing treatment • Managing the fearful child •


Cover image: Sheepcraig, Fair Isle, Hazel Walker. Oil on paper, 1991 Hazel Walker, born near Aberdeen in 1963, studied at Edinburgh College of Art between 1981 and 1985. This colourful, almost abstract study of Sheep Rock or Sheep Craig has a dream- like nature, unlike her


other landscapes which are often bleak and eerie.


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.


AUTUMN 2016


CHANGING FACES Adam Campbell discovers how


this innovative charity is working to make life more manageable for people with facial or other disfigurements


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CLINICAL RISK REDUCTION: PATHWAYS IN SIGHT


Dr Mark Wright champions the use of a unique set of diagnostic


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


algorithms for non-specialists faced with common ophthalmological complaints


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TREATING THE FEARFUL CHILD Paediatric dentist Fiona Hogg offers advice on dealing with dental anxiety in young patients


REGULARS 4 Notice Board


6 News Digest 8 Risk: Paying a high price 9 Ethics: A matter of judgement 20 Case studies: A bleak outcome, Two teeth too many, No blood wanted 22 Addenda: Object obscura: Powered toothbrush, Book review – The gene: an intimate history, Crossword and Vignette – Helena Rosa Wright, pioneering family planning practitioner


Please address correspondence to:


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


jkillgore@mddus.com


Design and production: Connect Communications 0131 561 0020 www.connectmedia.cc


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 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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