A 36-year old male patient saw his GP complaining of a cough. He had been, he said, reluctant to attend but his wife had cajoled him into it. He was keen to go on a rugby tour with his friends in a couple of days’ time and, in his view, she was fussing about nothing. The GP took the patient’s history and examined his chest but found no abnormality. The doctor advised the patient about the likely viral nature of the cough and told him to return if the condition did not improve.
That evening, on the way home from work, the GP bumped into the patient’s wife in the supermarket. The wife remarked that her husband’s ‘headache has got worse during the day’. Concerned about confidentiality, the GP did not disclose to the wife that her husband had failed to mention a headache. The GP was concerned but did not know whether or how she should act on the information. In the end, she did nothing.
The next morning, the GP learned that during the night the patient had been admitted to hospital by the out of hours service with viral meningitis. The wife later wrote to the GP surgery to complain that her husband’s condition had not been recognised and treated earlier. However, the husband did not consent to a complaint enquiry into the incident as he freely admitted that he did not mention his headache during the first consultation. Fortunately he made a full and uneventful recovery.
It is common for patients or their relatives to mention or ask about symptoms if you happen to meet outside the consulting room, for example when you encounter them in the surgery car park or at the corner shop. These so-called ‘corridor’ consultations present a number of potential ethical dilemmas for doctors, such as those concerning confidentiality and record-keeping.
First, it’s important not to dismiss what you are told just because the information is not delivered in a formal consultation setting. The patient or relative may mention something that requires you to act quickly if you think it is medically necessary. When the information is imparted by a relative or other third party, you should take care not to breach the confidentiality of the patient.
Although the patient in this case does not wish the incident to be lodged as a complaint, it is advisable to treat it as an adverse incident within the surgery. Discuss with the practice team the patient’s presentation and the doctor’s subsequent actions as a significant event. In particular, consider situations where chance encounters with patients occur outside the consulting room. The experience can provide useful lessons and a basis for improving policies and protocols in an attempt to prevent something similar happening in the future.
While a corridor consultation may not seem important to record in the patient’s notes, it would be advisable to document carefully what was said, in much the same way as telephone conversations and home visits are noted.
This page was correct at publication on 01/08/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.