Video: Anatomy of a claim

When a claim is brought against a doctor their notes about their patients care are critically important. This video looks at a scenario where a patient brought a claim against three General Practitioners in the same surgery, and how understanding the varied claims enabled us to support the doctors throughout the whole process.
 

 

Video transcription

[Dr. Davies] When a clinical negligence claim is brought against a doctor, their notes about their patient's care are critically important. In this case, a patient brought a claim against three GPs at the same surgery. Medical protection provided support throughout the whole process. When the patient in question visited his GP surgery with flu-like symptoms, Dr. A, prescribed antibiotics for a chest infection. A week later with similar symptoms, the same GP referred the patient for a chest x-ray and prescribed more medication. The x-ray was carried out the next day, at which point a second GP, Dr. B, let the patient know it was clear and he could carry on with his medication. A week later and a locum GP, Dr. C, assessed the patient and made detailed notes of his examination.

The patient was also suffering from muscular back pain, so the locum referred him back to Dr. A in a fortnight and recommended pain relief. At that appointment, Dr. A made a note of chest discomfort and referred the patient for physio, which took place five days later. The day after that, the patient collapsed due to a loss of feeling in his legs.

An MRI showed infective discitis and an emergency laminectomy was performed. Afterwards, the patient was left with paraplegia and was admitted for rehabilitation at a spinal injury unit. - [Dr. Stacey] Two years later, all three doctors received correspondence from the patient's solicitor indicating that they were pursuing a claim.

The doctors made contact with medical protection and the case was put in the hands of a specialist team, including a claims manager, a medical claims adviser, that's a doctor with legal training, and an on the record solicitor who dealt with the procedural matters. The team recognized that when doctors become the subject of claims of this nature, it can be distressing, so they provided details of the medical protection counseling service.

The allegation was that all three doctors, Doctors A, B, and C, didn't identify the diagnosis of infective discitis. And had they done so, action would have been taken to prevent the patient becoming paraplegic. Medical Protection instructed a GP expert to comment on the involvement of Doctors A, B, and C in the case and the expert was supportive.

On the basis of the expert report, a robust letter of response was submitted and that led to the case being discontinued against Doctors B and C. The claim against Dr. A went to trial, but Doctors B and C were called to give evidence. Medical protection instructed an experienced barrister to represent Dr.

A at trial. In advance of the trial, there are several conferences to make the necessary preparations. And those preparations paid off because Dr. A, together with Doctors B and C, came over very well in evidence. The same cannot be said of the patient. He had no clear recollection of whether or not he told Doctors A, B, or C that he had symptoms of back pain, hence did not come over as a credible witness.

The Medical Protection experts gave their evidence in a fair, measured and reasonable way. However, the expert instructed by the patient solicitor was discredited due to their lack of experience. Thankfully, at the end of day three, the claim discontinued, which came as a great relief to Doctors A, B, and C. -

[Dr. Perrott] Delayed diagnosis or misdiagnosis is one of the most common reasons for Medical Protection to have to settle a claim. In this particular case, what was really of importance was the number of doctors who were involved in seeing the patient and one of them was a locum. So, if you yourself are a locum or if you're employing people in your practice who come in and do shift sessions, then thinking about good medical records that allow for the continuity of care is of particular importance.

Although the outcome of this particular case, one could argue is successful at least from the doctors'point of view. You can imagine that the time and emotional energy spent by the various doctors concerned was huge. Because of this, Medical Protection strongly believes that trying to prevent claims and complaints from happening in the first place is an important part of the support that we offer our members.

We do this through our workshops focusing on communication skills, just to brush up, augment, and add to the communication skills that you probably already have. So it's a reminder of things like asking open-ended questions, listening to your patients' full monologue without interrupting, and then almost giving them a receipt at the end of it by summarizing the story that you've heard from it.

These are the sort of skills that we would discuss in our workshops like, "Mastering Your Risk" and some of them are online as well as resources if you're interested in looking at those skills in yourself. As well as supporting your individual resilience, these are system resilience factors that you might want to consider. Our workshop "Achieving Safer and Reliable Practice" looks at that very issue, strategies, tips, techniques that you might want to involve your systems in to try and reduce the risk of error.

In this case, Medical Protection managed to recover the legal costs of the three doctors.