Halloween hazards can lead to complaints

We share some fictitious medico-legal examples inspired by real cases...

Fancy dress costume causes offence

A dermatology registrar contacted the MDU after being notified of a GMC investigation. A former colleague had complained that a social media post about a fancy-dress outfit he had worn for a Halloween party was inappropriate. The post showed him wearing a straitjacket and an anti-bite, muzzle mask with a caption associating psychiatric patients and violent tendencies.

A consultant psychiatrist had seen the post and was concerned that the use of the costume along with his comment "perpetuated harmful stigma about mental health patients and promoted the idea that they are to be feared". The psychiatrist went on to say that when a member of the medical profession contributed to this harmful stereotype, it was even more problematic than a lay person doing so.

The GMC reviewed the complaint as part of their triage process and decided the issue did not call the dermatologist's fitness to practise into question and closed their investigation. However, they passed a copy of the complaint to the member so he could reflect and discuss it at his appraisal.

They also passed a copy onto the doctor's responsible officer for them to consider in the wider context of practice and revalidation. The doctor was shocked that the GMC had become involved in something unrelated to his clinical practice and sought our advice.

MDU advice

The MDU adviser sympathised with his concerns but explained that UK doctors had a duty to ensure their "conduct justifies your patients' trust in you and the public's trust in the profession." In addition, GMC standards state that you must not allow your personal views to affect your professional relationships with colleagues or the treatment you provide to patients.

With the help of the adviser, the doctor drafted his learning from the incident and as the responsible officer had no concerns about his wider practice the matter did not go any further.

You can find more in our guide on writing reflective statements.

Trip in the dark leads to missed fracture

A GP got in touch after NHS England informed her of a patient complaint. A patient in her 50s had complained that her ankle fracture had been misdiagnosed as a sprain. The GP remembered the consultation from the month before because the woman had tripped over at a murder in the dark party.

The GP examined the ankle and took a thorough history noting there was moderate swelling/bruising; no deformity; no neurovascular compromise and that there was no bony tenderness over the foot and ankle. She diagnosed a likely sprain along with the comment, 'X-ray not clinically indicated' and gave advice on analgesia.

The patient later had an ankle fracture diagnosed in hospital, requiring surgical fixation. They complained to the GP about the delay saying they may not have required surgery if they had been sent for an X-ray.

MDU advice

The GP, with assistance from an MDU adviser, drafted a response to the complaint. She apologised that the patient's fracture had been missed and detailed the examination, which followed the Ottowa ankle rules (OAR).

She explained the decision had been made after careful consideration of the OAR, although on reflection she should have explained this to the patient and recorded the reason for not referring the patient for an X-ray. She apologised for not providing the patient with information about what to do if her ankle didn't improve as expected.

NHS England's clinical adviser reviewed the response and was supportive. The patient did not pursue the complaint further.

For more information, read our advice on the importance of safety netting.

Foundation doctor spooked by haunted house incident

An FY2 doctor working in the emergency department had to submit a statement for an adverse incident investigation. The incident centred on an 18-year old patient who had experienced a delayed diagnosis of septal haematoma. The patient had been punched in the face by a startled customer while working as at actor at a haunted house experience.

The foundation doctor had carried out a full neurological and facial examination which demonstrated swelling and bruising over the bridge of the nose with mild bony tenderness but no obvious deformity or crepitus. There was no altered sensation around the area, no open wounds and some dried blood only around the entrance of both nostrils.

She diagnosed a nasal fracture, advised the patient to take analgesia and booked them in for an ENT follow up appointment a week later to reassess once the swelling had improved. She also explained under what circumstances the patient should seek further advice. All of this was noted in the records.

Two days later the patient came back to the department with increased nasal congestion, pain, headache and fever. The consultant diagnosed a septal abscess subsequent to a septal haematoma and made a referral to the ENT team for urgent surgery.

The consultant apologised to the patient for the delayed diagnosis and complied with the requirements under the duty of candour. The foundation doctor was asked to provide a statement and explain why an examination of the nasal septum hadn't been carried out or documented.

MDU advice

The MDU adviser assisted the member with her statement, in which the member confirmed that she had not checked the septum when assessing this patient. However, she was now aware of why doing so was important in nasal injuries, given the potential for an abscess or long term cosmetic defects from untreated septal haematomas.

She had reviewed the local guidelines on nasal fracture management for her department, planned to present the anonymised case with lessons learnt to her peers at a teaching session and had discussed the matter along with her learning with her educational supervisor.

For more info, read our guidance on responding to adverse incidents.

This page was correct at publication on 15/10/2021. 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.

Dr Ellie Mein MDU medico-legal adviser

by Dr Ellie Mein Medico-legal adviser


Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.