Wednesday, 16 March 2011

Doctor - Beware!

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.


  1. There are several issues here, aren't there, but the one you pinpoint is the failure of people to take resonsibility for themselves.

    I have an idea for a scheme to avoid wasted appointments, but which will also alert GPs if OPD appointments aren't kept. Every patient would be required to pay a deposit - not too large, and with concessions where appropriate - when they register with a GP. If they miss one appointment, they are placed on alert. If they miss the second - whether it's a GP or hospital appointmnet - they lose their deposit and have to re-register (and, of course, pay again). This would require a little time and money to administer, but would save money in the long run. What do you think?

  2. Thanks Frances. The situation is that the Courts have never tended to allocate blame on patients in these situations. In these times when we pay much lip service to rights and responsibilities, the Courts perceive first responsibilities to the health care professionals. I do understand that their decisions are carefully considered with much attention paid to expert witnesses.

    Any thought of payment made by patients for core services is a poitical no-no. The principle of health care being free and the point of contact is absolutely at the core of the NHS. OK, so dentists can charge for failure to keep an appointment, but never GPs or hospitals. I wonder if the thinking behind that is that by and large people do not die of dental problems, not in the short term anyway. GPs are often presented with vague and rather undefined symptoms. Mostly these don't represent serious underlying disease, but one in a thousand, say, will do. So if doctors are seen to be discouraging patients from coming to do so, they do it at their peril.

    No - the only way of avoiding tragedies like The Times story is for doctors and their staff to be vigilant and absolutely meticulous. And to be grateful to any patient who plays their part as well!

    By the way - I went to see one of the health care assistants at my surgery recently for a routine blood test. To be followed up by a telephone consultation from the Nurse Practitioner. The HCA was enough on the ball to ask if my phone number on their records was the correct one. The computer had got one that was years out of date - transferred from a surgery where I was previously registered.

  3. Glad to read you have hung up your stethoscope for good! Being sued seemed like enough of a minefield when working regularly. So pleased to no longer have to worry about that now!