CONTENTS TITLE IN THIS ISSUE


GOOGLE recently announced that around five per cent of queries on its search engine are for health-related information. Considering Google now processes over 40,000 search queries per second, that translates into a lot of medical advice being imparted. So it’s probably safe to assume that your average patient is today better informed (or misinformed) than say 20 years ago. Given such democratic data access, a sea change in patient


expectations and the nature of what constitutes informed consent is inevitable. Not to say this was the only or even a key factor in the recent landmark legal judgment of Montgomery v Lanarkshire Health Board. But the Courts have now recognised that in assessing risk the emphasis must be on what a “reasonable person in the patient’s position would be likely to attach significance to” and not necessarily what a “reasonable doctor” would consider risky. On page 14 Gail Gilmartin looks at the implications of the case.


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16 SUMMONS SPRING 2015 AN PUBLICATION FOR MEMBERS


Cover image: ‘Dubh Beinn, Jura’ Julie Brook Oil on canvas. 1999


• Freedom to speak up • A reasonable patient • The price of perfection •


Born in 1961, Julie graduated from Ruskin Scool of Art in 1983. Her early work was inspired by trips to the Hebrides and Orkney. She has been involved with educational


projects in the Highlands, and recently exhibited at the Dovecot Gallery in Edinburgh.


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.


SPRING 2015 In the last issue of Summons, departing CEO Gordon Dickson


offered his perspective on 10 years of transformation at MDDUS. On page 10, the new CEO Chris Kenny offers his view of the challenges facing the Union in the coming years. On page 18 Doug Hamilton looks at some of the thorny ethical


questions around cosmetic dental treatment. In such procedures, he points out: “there is little risk in doing nothing, other than the likelihood that patients will remain dissatisfied with their smiles”. Does the answer lie in more rigorous consent? Earlier this year Sir Robert Francis introduced his long-


awaited review of whistleblowing within the NHS – Freedom to speak up. On page 12, I summarise some of the findings and his recommendations. And our regular clinical risk article (p. 16) is on the diabetic


foot and complications that may lead to amputation. Jim Killgore, editor


LOOKING AHEAD New MDDUS CEO, Chris Kenny,


offers a perspective on some of the challenges ahead both for MDDUS and UK healthcare in general


SPEAKING FREELY Jim Killgore reports on


proposed new measures to protect whistleblowers


A REASONABLE PATIENT A recent landmark case has clarified the legal position of informed consent. Medical adviser Dr Gail Gilmartin looks at the judgment


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CLINICAL RISK REDUCTION Professor Graham Leese looks


at pitfalls in identifying diabetics at risk of lower limb complications leading to amputation


Editor:


Jim Killgore Associate editor: Joanne Curran


Editorial departments: MEDICAL Dr Richard Brittain DENTAL Mr Aubrey Craig LEGAL RISK


Simon Dinnick Peter Johnson


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THE PRICE OF PERFECTION Is it fair to criticise the


so-called “destructodontics” of aesthetic dentistry? MDDUS dental adviser Doug Hamilton offers a perspective


REGULARS 4 Notice Board


6 News Digest 8 Risk: Where do claims appear in primary care? 9 Ethics: Lessons from my father 20 Case studies: A wrong message, Operative risk, Reluctant to review 22 Addenda: Cancer dreams, Herbal remedies, Crossword and Vignette: Robert Seymour Bridges, doctor and poet


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 benefits 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 reflect the opinions or policies of The Medical and Dental Defence Union of Scotland.


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