The Medical Defence Union today revealed that there has been a 50 per cent increase in the complaints related to out-of-hours (OOH) consultations notified by its GP members. OOH complaints also represented an increased proportion of the total complaints against GPs compared to a similar MDU study in 2007.
The Medical Defence Union (MDU), the UK's leading medical defence organisation, revealed it had been notified of 517 complaints related to out-of-hours consultations by GP members in 2007 and 2008, compared to 337 in the previous two years, an increase of 53 per cent*. OOH complaints now represent around 10 per cent of the annual total of GP complaints, compared to 8 per cent in the previous two years.
Dr Stephen Green, head of risk management at the MDU, said: "Compared to the many millions of patients who are seen out-of-hours each year, the number of complaints notified to us by our members is small. However, OOH care continues to represent a significant and growing proportion of the complaints we see. This analysis also highlights the communication challenges associated with OOH consultations which may make a complaint more likely if something goes wrong, compared to consultations within surgery hours. For example, OOH consultations are generally associated with high levels of stress and anxiety for patients and their families: there may have been a wait to be seen by a doctor they have never met before; and they may feel more vulnerable because it is the middle of the night.
"For their part, OOH doctors are unlikely to have an established doctor-patient relationship, and if there is a problem, they are unlikely to have an early opportunity to see the patient, talk about what happened, offer an apology if appropriate and explain what can be done to prevent a similar incident. In the MDU's experience, this kind of response can often be enough to reassure the patient and reduce the possibility of a complaint.
"With these factors in mind, we are advising OOH doctors to pay particular attention to the need for clear, unambiguous communication with patients and colleagues, including accurate and comprehensive note-taking and arranging follow-up if necessary."
The MDU also revealed there were 73 claims related to OOH consultations over the two years of the study, compared to 41 in the previous two years. However, only two claims have been settled to date and in the MDU's experience, around two-thirds of claims are discontinued or unsuccessful.
The main themes highlighted in the MDU study included:
- 120 complaints and 52 claims included allegations of apparent failures or delays in diagnosis or referral. The most common conditions involved were myocardial infarction, septicaemia and meningitis. While it is inevitable that diagnoses will occasionally be missed, the MDU advises doctors to undertake and document the patient's history and examination, including relevant negative and positive findings.
- 75 complaints and 17 claims were made following the death of a patient. It is impossible to rule out a sudden deterioration in a patient's condition but it is important to review any diagnosis if there is any change and explain to patients and careers what to do if the condition does not improve.
- 71 complaints included allegations of rudeness or that the doctor had an uncaring or off-hand manner. One case featured an allegation that the doctor was chewing gum during the home visit.
- Problems with telephone triage featured in 19 complaints. In one case, a GP assessed a patient with abdominal pain and prescribed medication without visiting the patient, who later developed appendicitis.
- 13 complaints and claims in the study were referred to the General Medical Council (GMC). Four followed the death of a patient; two were sexual allegations and the majority of the rest related to poor performance.
Source
Medical Defence Union
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