The most common reason foundation doctors called our medical advice line was for advice about a report for the coroner. A coroner will often need written reports from those involved in the care of a deceased patient. Such requests can make an already distressing time even more stressful for the clinicians involved.
Most doctors will produce at least one written report for the coroner during their career, and a well written report may avoid the need to attend the inquest so it is important to know how to handle such a request.
The coroner needs your help in understanding what happened and what your role was. Their request does not necessarily mean there is any specific concern about your input into the case, just that you may be best placed to describe an episode during the patient's care.
Co-operate with the request
Whether the request has come straight from the coroner or via the trust's legal team, it is important to note any deadline and respond to the request as promptly as possible. Read the request carefully in case there are any specific issues you have been asked to address.
Make sure you have all relevant information
You should be provided with the relevant clinical records.
Ask for help
Discuss the case with your clinical or educational supervisor to obtain feedback and support; they can help reassure you and offer guidance on your statement.
Remember to be comprehensive and clear in your statement. For advice about writing statements, see below.
Writing an adverse incident statement
The second most popular reason for foundation doctors to call our medical advice line was related to adverse incident investigations. The majority of these calls asked for advice regarding writing an adverse incident statement.
When writing any formal statement, ensure that the report is a clear, factual and detailed account of events as well as considering the following points:
- Explain who has asked you for the statement and for what process.
- Ideally, you will have had access to the notes to write your statement, but always explain what you are basing your comments on – the notes, your memory, or your usual practice?
- Introduce yourself to the reader. What are your relevant qualifications and experience? How did you come to be involved?
- Focus on your own involvement. Give a chronological account, including the full history and examination findings. This should be written in full sentences, explaining any abbreviations or medical terminology, and including the negative as well as positive findings.
- Where possible, give specific dates and times.
- Provide the full name, dose, route and lay description of any drugs mentioned.
- Address any specific questions you have been asked.
- Write in the first person – for example, 'I examined the patient', rather than 'the patient was examined'.
- Check your statement carefully before you submit it.
- Keep a copy of your final statement in case you are called to give evidence at a hearing or tribunal.
Foundation doctors also call our medical advice line to seek assistance with a police investigation. Usually, this is not related to the doctor's clinical work but from an external incident, such as a motoring offence.
The thought of having a criminal record is understandably very distressing for the doctor involved, regardless of the nature of an alleged criminal offence.
Consequently, it is important to undertake the following steps if you find yourself subject to a potential criminal investigation:
- In the first instance, seek advice from your medical defence organisation and/or a solicitor.
- If it is a clinical matter, don't try to produce a statement without the notes and advice from your medical defence organisation.
- Never make the mistake of thinking that the police won't know the subject matter. Any interviews will likely be conducted by skilled officers.
- If you are approached by the media, remember you have a duty of confidentiality to any patient involved.
- You may need to notify the GMC if you accept a caution or if you are charged or convicted of an offence. Seek advice from your defence organisation about your obligations.
Dealing with a complaint
Another reason foundation doctors called the MDU's advice helpline related to dealing with a complaint. Responding to a complaint is not pleasant for any doctor, no matter how long you have been in the profession. There are a few factors you will need to consider when composing your response.
Verbal complaints may still be considered formally. The NHS complaints regulations give clear time limits in which complaints need to be acknowledged, and the organisation should have told the patient when the response will be ready. You should assist the complaints team in meeting those deadlines.
There should be a senior person from the organisation who is overseeing their response to the complaint. This may need to bring together comments from various clinicians and even different NHS bodies (such as the GP, ambulance service and A&E staff).
How to respond
When responding to a complaint, make sure you follow the steps below to maximise your chances of resolving the patient's concerns at an early stage.
- Seek advice from your medical defence organisation.
- Respond to the complaint in a thoughtful and reflective manner, reviewing both the complaint, any relevant records and a full description of your involvement (see the guidance above on writing statements for tips on this).
- Identify any learning points from clinical management and other aspects such as documentation or administrative support, which can be used to improve future patient care.
- Be open and honest with the patient, offer an apology where appropriate and explain what has happened and the next steps.
- Discuss any complaints that you receive at your next annual appraisal or training review. This will ensure you are complying with GMC requirements and demonstrates that you have responded to the criticisms in a responsible way.
Hopefully your full, prompt, open and clear account will allow the complaint to be resolved locally. However, if the complainant is not satisfied they can take their concerns further, for example to the Ombudsman. The MDU can advise you on what to do regarding any further investigations that arise.
This page was correct at publication on 25/07/2018. 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.