Learning from cases - OncologyArticle

Common themesDividing RuleAdviceWe receive a large number of requests for written advice on a wide range of medicolegal issues, with common themes. These include:

Guidance on whether or not it would be appropriate to accept a high value gift from a patient.

Managing patients who seek a report for the purpose of attending Dignitas or a similar clinic with the intention of ending their life.

Raising concerns about delays or inadequacies within services, including staffing levels and PPE.

Duty of candour obligations following misdiagnosis or delayed diagnosis.

Prescribing of unlicensed medications.

Prescribing for patients residing abroad.

Managing negative online reviews written by patients or relatives.

Concerns in relation to patients recording consultations without the knowledge of the clinician, and what the patient is entitled to do with such a recording, for example, posting it online.

Queries in relation to the pandemic and the changes to working practices, such as the risks of conducting primarily telephone reviews, rather than face-to-face consultations.

Completion of Fit to Fly Certificates for holidays or for returning to a home country for end-of-life care.

ReportsAssistance was provided in over 50 report case types, including clinical negligence claims being made against Trusts, or for serious untoward incident investigations. The common themes identified include:

Incorrect diagnosis leading to inappropriate treatment.

Poor clinical care during hospital admission.

Chemotherapy errors resulting in the patient receiving an excessive dose, including errors arising from incorrect height and weight details being recorded for the patient.

ComplaintsMedical Protection assisted in responding to over 60 complaints arising from both NHS work and private practice. The majority of complaints come from patients or their relatives, but we also see complaints from other healthcare professionals, particularly related to communication, manner, and attitude. Common themes seen in complaints include:

Delayed diagnosis.

Failure to recognise disease progression.

Inappropriate intimate examination.

Inadequate consent for treatment, including failure to discuss possible adverse effects, or failure to discuss alternative treatment options (including that of no treatment).

Poor manner and attitude, including rudeness and lack of empathy when breaking bad news.

Poor communication with other specialties.

Inquests
We assisted members in writing statements and attending coroners’ inquests on almost 60 occasions. An inquest is a fact-finding exercise that is conducted by the coroner, and in some cases, in front of a jury.The purpose of an inquest is to find out who died, when, where, how, and in what circumstances. Our Inquest Factsheet contains further information about what happens at an inquest.Our analysis identified the following themes, some of which were also seen in other cases:

Chemotherapy errors – resulting in the administration of an excessive dose, leading to concerns that this may have caused or contributed to the death of a patient.

Death from pulmonary embolism.

Death resulting from industrial disease.

Adverse reactions to chemotherapy, including anaphylaxis.

Death from neutropaenic sepsis. Delays in diagnosis or treatment, with consideration by the coroner as to whether this contributed to the death.

Deaths occurring as a result of bowel ischaemia or bowel perforation.

Regulatory (GMC) and disciplinary casesWe are aware of the immense pressure and stress that many doctors go through during these investigations. We always aim to provide members with tailored care and expert support. GMC cases and hospital disciplinary matters have followed concerns raised by patients, relatives, or colleagues – both senior and junior. There was a mix of clinical and non-clinical concerns, but some investigations related to more than one concern or a series of serious clinical incidents. The common themes were:

Allegations of fraud in relation to private practice billing or referrals to the private sector.

Concerns in relation to delayed diagnoses or failure to offer treatment.

Clinical decision making, particularly in relation to chemotherapy prescribing.

Health issues, such as drug misuse or excess alcohol use, including drinking when on call.

Allegations of sexual assault and violence occurring outside the work setting.

Attendance at work or failure to self-isolate when knowingly COVID-19 positive – despite restrictions in place at the time.

Bullying and poor working relationships with colleagues.

Poor communication with patients.

Failure to obtain adequate consent for treatment, including with respect to clinical trials.

Where regulatory matters related to a single clinical concern, these were often closed, either at an early stage following an expert report obtained by the GMC – which did not raise significant concerns about the clinician’s practice – or following written reflection and evidence of learning presented to the GMC, without progression to the Medical Practitioners Tribunal Service for a hearing.In cases involving probity, there is a high likelihood that a referral will result in a hearing, as illustrated by the following case study.
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Learning from cases - OncologyArticle - IntroductionArticle - AnalysisArticle - Case StudyArticle - Common themesArticle - Case Study 2Article - Oncology in the UK: top tips to minimise riskEnd Page