Frightful side effect of herbal treatment
A GP saw a patient with an unusual looking skin lesion on their cheek. The patient explained that it had started off as a mole but had changed over the last few weeks to more than triple in size. The affected area had turned necrotic and the surrounding area had become red and swollen over the last 48 hours. However, the patient was systemically well.
The GP prescribed oral antibiotics and referred the patient to dermatology under a two-week wait pathway. The GP also advised the patient on what to do if things worsened.
As the GP was writing the referral, they asked the patient if they had been applying any antiseptic cream or topical treatments to the lesion as it looked unusual. The patient explained they had been applying black salve containing bloodroot for a while, which is a herbal ointment.
The GP looked up the treatment and realised that it was an unregulated treatment and could be corrosive. She advised the patient to stop using it immediately. She also called the dermatology registrar who advised the patient be seen by them promptly due to the potential for secondary infection.
The patient required intravenous antibiotics and subsequently reconstructive surgery for the large crater in their cheek. A biopsy demonstrated extensive tissue damage.
MDU advice
This case demonstrates the importance of taking a full history, including asking the patient if they are taking over-the-counter medications and alternative remedies. This is especially important if you plan to prescribe medication as there may be a harmful interaction.
The GMC's Good medical practice (2024) highlights this in paragraph 39: "You should ask patients about any other care or treatment they are receiving – including over-the-counter medications – and check that any care or treatment you propose, provide or prescribe is compatible."
Unlucky encounter with a black cat
A teenager attended the emergency department with a badly cut lip. They had tripped over a black cat who had crossed their path and landed face down. The registrar saw them but before she could suture the wound, she was called to an emergency. She asked the ST1 to suture the facial laceration so the patient could go home.
The ST1 realised the laceration was across the vermillion border and was deep. He had not sutured a lip before and had been warned at induction about the need to ensure the alignment of the vermillion-cutaneous border was preserved. He wasn’t sure if he could achieve a good cosmetic result.
He explained this to the patient then spoke to the registrar. As she was busy, she asked him to check with the maxillofacial registrar who reviewed the patient and closed the wound.
MDU advice
It can be daunting to ask for help with an unfamiliar procedure, especially when more experienced colleagues are busy. However, you must work within your competence and expertise.
Good medical practice (2024) explains that, "If a task is delegated to you by a colleague but you’re not confident you have the necessary knowledge, skills or training to carry it out safely, you must prioritise patient safety and seek help, even if you’ve already agreed to carry out the task independently."
Doctor with Wiccan beliefs mocked
A junior doctor asked several colleagues to swap a shift with her on Halloween with no success. She explained to her peers during a teaching session that she wished to swap so she could celebrate All Hallows' Eve in keeping with her Wiccan beliefs. She received a mixed reaction from colleagues with some curious and others expressing disgust or derision.
Several jokes were made at her expense, including people asking her if she wore a witch’s hat or sacrificed animals. However, a colleague agreed to swap with her and checked she was OK after the teaching session.
A consultant noticed the doctor was visibly upset and was told about the comments. The junior doctor didn't wish to escalate the matter but agreed for the consultant to raise it with the colleagues concerned.
At this meeting, one of the doctors argued the exchange was just banter and no harm was intended. He also said the belief wasn’t protected under the Equality Act 2010. The consultant pointed out that regardless of the legal position, doctors should be aware of the relevant GMC guidance, and asked each of them to reflect on their part in the discussion and their own beliefs and biases, which weren’t aligned with GMC standards. They apologised to the junior doctor for mocking her beliefs and the matter was resolved.
MDU advice
The latest version of Good medical practice (2024) emphasises the importance of workplaces that are "fair, free from discrimination, and where they’re respected and valued as an individual." Paragraphs 52-56 expand on this, stating that doctors must not "abuse, discriminate against, bully, or harass anyone based on their personal characteristics…" These characteristics not only include those protected by legislation, such as religion or belief, but also wider aspects like lifestyle and culture.
Religious discrimination is a protected characteristic under the Equality Act. It is possible for followers of less well-known religions such as Paganism or Wiccans to allege religious discrimination in the workplace.
This page was correct at publication on 10/10/2023. 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.
by Dr Ellie Mein Medico-legal adviser
MB ChB MRCOphth GDL LLM
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.