COMPLAINT ELDERLY VISIT


BACKGROUND Mrs M is 92 years old and a widow living at home. She is frail with progressive heart failure but mentally competent. A carer arrives one morning to find Mrs M confused and in distress having wet the bed. She calls her son who lives nearby and he contacts the local GP surgery requesting a home visit. Dr G attends late in the morning and


examines the patient, noting that Mrs M has a slight temperature. The GP suspects a urinary tract infection and says he will arrange for an ambulance. In subsequent discussion he mentions the option of full-time care for Mrs M in a residential care home. She overhears his comment and becomes very upset. This has been a topic of discussion with her son and Mrs M is adamant about wanting to remain at home. Dr G returns to his car and phones for an


ambulance and just as he finishes writing up his notes the ambulance arrives. He has a quick word with the paramedics and then departs for another house call. Two days later a letter arrives in the


practice from the patient’s son complaining of insensitive treatment in the care of his mother. He says it was not appropriate to raise the question of her ongoing care in those circumstances, when his mother was clearly distressed and suffering mild delirium in association with her UTI. He also states that Dr G left the house without informing them an ambulance was on the way.


ANALYSIS/OUTCOME The practice manager contacts MDDUS on behalf of Dr G to ask for help in dealing with the complaint. First she is advised to ensure that Mr M has consent from his mother to deal with the issue. A simple mandate can be sent to Mrs M to sign and return stating clearly that aspects of her medical records may have to be disclosed in order to respond to her son’s concerns. Dr G then drafts a response and this is


reviewed by the practice manager and an MDDUS medical adviser. In the letter he expresses his regret for the distress felt by Mrs M and acknowledges that he could have been more discreet in his discussion of her ongoing care. He also offers an apology for not returning to the house after phoning the ambulance. Dr G offers to further discuss the


complaint and also informs Mr M of his right to recourse to the ombudsman. Nothing more is heard from Mr M and his mother remains a patient at the practice.


KEY POINTS ●Competent patients should be involved in discussions about their care. ●Ensure patients/carers understand what follow-up is being arranged.


ADVICE NOTIFIABLE DISEASE


BACKGROUND A GP in London reviewing the results of a blood test for a patient – Mrs O – discovers that it has come back positive for hepatitis C. In attempting to contact her Dr A learns that Mrs O has travelled to Senegal in order to care for a sick relative and is not expected back anytime soon. The only contact number is a local landline which goes unanswered. Mrs O’s ex-husband is also registered at the practice and Dr A phones MDDUS to enquire about the legality of contacting him in an attempt to ascertain the patient’s whereabouts.


ANALYSIS/OUTCOME An MDDUS adviser writes back to the GP advising that there are both statutory and


professional guidelines to follow in this circumstance. Medical practitioners have a statutory duty to report notifiable diseases, including hepatitis C. Doctors are obliged to disclose this information whether or not the patient consents, and Dr A is advised to notify Public Health England. GMC guidance advises that patient


confidentiality is an important duty but not absolute. Doctors must disclose information when required to by law or to satisfy a specific statutory requirement, such as the notification of a known case of infectious disease. Patients should be informed of this disclosure if practicable. In this case, the concern is not just that


the patient might object to disclosure but also that she is as yet unaware of the


diagnosis. The MDDUS adviser informs the GP that careful thought should be given to GMC guidance relating to public interest disclosure if he is considering contacting the husband. He advises that the responsibility to investigate further should now lie with Public Health England – including attempts to contact the patient.


KEY POINTS ●Medical practitioners have a statutory duty to report notifiable diseases, even without patient consent. ●Ensure disclosure (inadvertent or not) is within your area of responsibility.


MDDUS INSIGHT / 17


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