A report in ‘The Times’ (15th March 2011) should cause every practising doctor to sit up and take notice. It concerns a court case in which a doctor was found to have committed a ‘breach of duty’ as a consequence of his secretarial staff at the surgery having recorded incorrectly a patient’s address in a referral letter (the house number was given as ‘16’ when it was in fact ‘1b’). The woman never received her hospital appointment, did not contact the doctor to find out why, and she died of cancer a little over 2 years later. She had originally attended with a breast lump and the doctor agreed that a specialist referral was needed. The judge deemed him to have been at fault for failing to ‘ensure that she had attended the appointment’. The woman’s orphaned son is now entitled to compensation from the GP’s medical indemnity insurer.
My guess is that many, but by no means all doctors, who refer patients to hospital, will have a system in place to ensure that an appointment is offered and attended. When I was in practice I would routinely say to patients that they should make contact with me or the hospital if they were not sent the expected appointment notification. But I do wonder if it was entirely fair in this instance that the GP should have been allocated the entire blame for the outcome. Did the hospital clinic, for example, not notify him of the woman’s failure to attend the appointment? And there is a slightly worrying implication that patients are somehow less beholden to be responsible than their doctors. The patient herself, it appears, was worried that she had cancer, yet why she apparently did nothing when the appointment letter failed to arrive was not established. But the bottom line, of course, is that the doctor would have signed the referral letter before it was sent, and the presumption must be that he would have read it through to ensure that the detail was correct.
Many years ago a man who was clearly very unwell attended my surgery. I arranged some blood tests and in fact took the blood specimen myself on the same day. I received a telephone call from the laboratory that afternoon to say that he had acute kidney failure and required immediate admission to hospital.
When I called the number he had given us on registering with the practice it appeared that it was no longer in use. He didn’t live far away, so as soon as I had a spare moment I drove to his address. The woman who answered the door told me that he had not lived there for two years and, no, she had no forwarding address.
We moved heaven and earth to try to find him. Even the police drew a blank. But a few days later he did pitch up again, now desperately ill. He died in hospital a few days later.
Would a judge have found me at fault were the man’s family to have sued me? No, I think not, as I had done all I could to find him. But over the years I became aware, time and time again, of patients who seemed to think it not to be a priority to inform their doctor of a change of address or telephone number.
OK, my scenario and that of the GP whose secretary mis-typed the house number are not really comparable. But putting the whole blame on the GP sounds not entirely fair to me.
In the last year that I worked full time in my GP partnership in London, my medical indemnity subscription (insurance with the Medical Defense Union) was just a little short of £5000 per annum, met out of my own pocket. By good fortune I was never once sued during the whole of my career.
When I ‘retired’ to Wiltshire and took up part time locum work the subscription was reduced – currently a little under £2000 a year, provided that I work no more than 4 days a month. The case reported in today’s ‘Times’ prompts me to take action: I will cancel the subscription entirely and finally hang up the stethoscope for good. It simply isn’t worth it.
And I feel slightly sick when I ponder to myself just where all the tens of thousands of pounds of money I have paid to the MDU over the past 40 years has gone to.