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GMC ASSAULT ALLEGATION


BACKGROUND A specialist trainee in emergency medicine – Dr D – is working a Friday evening shift in a busy inner city hospital. A 15-year-old boy attends reception with his mother, having fallen in the street. He is bleeding from a cut above his eye and clearly inebriated, swearing at the charge nurse. The patient is taken through to the


treatment area but refuses to be examined and becomes aggressive. In an attempt to restrain the boy Dr D grabs him by the shoulders. His mother intervenes and the boy calms down such that he can be treated. A week later Dr D is visited by police at


his flat and cautioned and charged with common assault against the boy. Dr D phones MDDUS and is advised to


inform his employing trust and the GMC. A Rule 4 letter later arrives from the GMC stating that his case will be investigated to determine if further action might be necessary with regard to his fitness to practise.


ANALYSIS/OUTCOME MDDUS works with Dr D in composing a response to the GMC letter, explaining the circumstances behind the assault charge. He describes how the patient became


increasingly loud and disruptive, such that other patients were becoming alarmed, and his only intention was to calm the boy down. Other witnesses, including nursing staff, support this version of events. The GMC contacts the trust, which confirms that it has carried out a risk


KEY POINTS ●Be mindful that you will have to justify any actions you take in dealing with difficult and aggressive patients. ●Be aware of your legal rights/obligations and relevant guidance in regard to treating aggressive patients. ●Make a record of adverse incidents while events are fresh in your mind.


assessment and ensured that Dr D is chaperoned while the charges are pending. The GMC investigator also contacts the doctor’s responsible officer (RO) who states that having spoken with witnesses he believes Dr D has done nothing wrong. The RO also reports that Dr D has undertaken reflective practice involving how he should behave in future with such patients. Dr D is given a date for a court


appearance but is later informed by the prosecutor that no further action will be taken against him and the matter is closed. This is communicated to the GMC who later responds that its case examiners have considered the information provided and decided to conclude the case with no further action.


ADVICE PRIVATE INTERPRETER


BACKGROUND A dental hygienist, Ms H, emails MDDUS for advice regarding a 52-year-old patient, Mr Z, who speaks no English. He suffers poor oral health and has been referred to her for treatment on a private basis. Having looked at recent radiographs and carried out an initial examination, Ms H is of the opinion that Mr Z suffers from chronic periodontal disease affecting most of his teeth. The hygienist notes that, with reference to the dental records, Mr Z, in discussion with his dentist has declined to see a periodontist. Ms H has thus recommended four further appointments with her for quad root surface debridement under local anaesthetic. She has tried to communicate her treatment plan using Mr Z’s wife as a translator, but her English is very limited and Ms H is concerned the


patient does not fully understand what is being proposed and the risks/costs involved. Ms H asks whether she should have refused to see the patient and how she should proceed, being aware of her ethical obligations regarding communication with patients (Standards for the Dental Team GDC 2013)


ANALYSIS/OUTCOME An MDDUS adviser responds in writing and reassures Ms H that she behaved correctly by seeing the patient and by recognising his difficulties in understanding the proposed treatment. As the patient was referred on a private basis, Ms H is aware the NHS would not cover the cost of an interpreter. Therefore, the MDDUS adviser explains it would be acceptable to add this cost to the patient’s treatment bill. Alternatively, Ms H


could offer to refer the patient back to his original dentist who could perform the treatment under the NHS, with the aid of an NHS-funded interpreter. The key is to ensure all of these options are clearly explained to Mr Z and discussions documented in his record.


KEY POINTS ●GDC guidance clearly states that clinicians should explore options to meet particular communication needs. ●Consider using a professional interpreter rather than a friend/ relative. ●Explain/document all available options, including cost.


MDDUS INSIGHT / 19


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