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An apparently uneventful consultation can come back to haunt doctors, sometimes many years later. Dr Nicola Bailey, our newest member of the medical claims team and former GP, explains to interviewer, Susan Field, why nothing can ever be routine in general practice.
Following a busy morning surgery, GP Nicola Bailey was on her way out to make a home visit. As she left a receptionist asked if she could spare a moment to sign a prescription for co-codamol*, a drug the patient had been prescribed before for her back pain.
She remembers: "Although it sounded OK, for some reason an alarm bell went off in my head and I decided to go back and check the patient's records. It was only then I discovered she had picked up a two-week supply of co-codamol just a few days before. There could have been a reasonable explanation but it was also possible that the patient was overusing because she was unable to control her pain or more ominously she might be depressed which would make it dangerous for her to have that amount of the drug in her possession. If I had signed the prescription without checking, I could have put the patient at risk and put myself in a terrible position."
The incident shows how easy it is for an apparently innocuous encounter to have potentially dreadful consequences, something that has been brought home to Nicola during her first few weeks in the MDU's claims team.
The former GP partner in Greater Manchester had long been interested in medico-legal work but despite her knowledge of the legal process, Nicola's introduction to the world of clinical negligence has changed her perspective on her own career in general practice.
She says: "I always assumed that if I received a claim it would be for a terrible mistake with immediate repercussions for the patient but since I began my training at the MDU it's been brought home to me how many seemingly ordinary jobs have the potential to go wrong without my even noticing."
Take the routine task of reviewing blood tests. Nicola recalls she used to check up to 60 results each day: "The lab had a fail-safe system so anything outside certain parameters would prompt a phone call to the practice. When a blood count did not trigger the fail-safe but was still outside the normal range, it was up to us to spot it and check the patient's records. I used to take a break if I felt I'd begun to work on autopilot but it's easy to imagine a situation where I had become distracted for a moment, pressed return and brought the next record up. What if that split second's inattention meant that I had missed a case of anaemia in an elderly patient, something which might easily be a symptom of bowel cancer? That might have caused a delay in reaching the correct diagnosis and adversely affected the patient's prognosis. It could also have left me vulnerable to a clinical negligence claim."
Allegations of delayed diagnosis and referral are actually one of the most common reasons for claims against GP members. Between 2008 and 2012 we paid out over £28million on behalf of GP members to settle 17 negligence claims involving delayed diagnosis of meningitis. But as Nicola explains, while meningitis is thankfully rare, the early features are often the same as those of minor viral illnesses which require no treatment. "A GP might only see one or two cases of meningitis in a lifetime of practice but they will see large numbers of feverish children and adults. Making the wrong call could be devastating for the patient, potentially causing serious irreversible injuries such as brain damage and the loss of limbs. It is also likely to result in a claim."
"Failure to diagnose a patient's condition is not necessarily negligent", she adds, "unless the GP is unable to demonstrate their management was of a reasonable standard. That's why it is so important to keep a full clinical record of all interactions with patients, whether in person or by telephone or email. A note of your differential diagnosis, management plan and what you advised the patient is important for patient care and far better than relying on your memory or usual practice, especially as you might not receive a claim until many years after the consultation."
Nicola has been surprised at the size of the claims she has seen in her first few weeks at the MDU and suspects GP members would be alarmed to hear that awards of £5million or more are not unusual. This is because in addition to general damages for pain, suffering and loss of amenity arising from the injury or illness, the claimant is entitled to special damages for the financial consequences such as loss of earnings and the cost of care over their projected life span. The MDU's largest ever pay-out for a GP member was for a delayed diagnosis of meningitis in a child under one year old who required a high level of long-term care. It was settled for £6.8million in 2009.
However, even if the MDU and the member agree that a claim should be settled, Nicola and her colleagues still need to negotiate with the claimant's lawyers to determine a level of compensation which is fair to both parties. She reflects: "Negligently damaged patients should be compensated but we must try to ensure the level of compensation is appropriate in the interests of all our members and the public. After all, it's not in anyone's interest for claims awards to inflate beyond society's ability to pay for them.
That is also why the MDU has called for a cap on future care costs and loss of earnings awards among a package of reforms to the civil claims system."
This is more important than ever because in the last decade, the MDU has seen the number of claims against medical members rise sharply – new claims notifications increased by 15% in 2012 alone although there is no evidence that clinical standards have slipped.
For Nicola, becoming a member of the claims team is a chance to defend and support hard-working GPs who are often shocked and distressed to receive a claim. "When I first qualified as a GP," she remembers, "I was distantly aware of the risk I could receive a claim but sadly this has almost become an everyday hazard for the profession. Yet it's also true that many of the incidents which prompt claims rarely stand out as significant moments in a GP's day and I'm sure that like me, many GP members might experience an uncomfortable twinge of recognition when they hear about the circumstances and understand that it could easily have happened to them.
It seems to me that the key to avoiding becoming one of the statistics is being aware of the potential risks in everyday situations and taking steps to address them, from implementing systems which flag up missed reviews and high risk medication to ensuring that lessons are learned from every significant event.
Clinical negligence is a highly specialised and complex area of law and certainly not something that doctors would ever want to face alone, quite apart from the eye-watering sums involved. So if the worst does happen remember to alert the MDU's claims team straight away for expert support and advice. After all, it is what we are here for."
*Details changed to preserve confidentiality.
This page was correct at publication on . 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.
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