You have been treating a 35 year old woman for four years.
the patient present; do not just give the patient a referral
During that time she has had classical migraine symptoms which
usually respond to ergotamine and analgesics. In the last year
4. Maintaining contact with the patient and enquiring
they have been more frequent and prophylaxis with Deseril has
periodically about their progress may help the patient
cope with the feelings of concern over the diagnosis or any
She again presents with the usual symptoms but has noticed
possible delays. Expressions of personal concern and interest
some face numbness and a more frequent pattern of occurrence.
in what has occurred (i.e. an admission to hospital or other
A CT scan report shows a 4 cm meningioma in the right temporal
treatments) is part of good ongoing care and will assist in the
area which clearly has been there for a long time.
ongoing doctor-patient relationship.
5. Offer ongoing care when the crisis period has past. If you How to handle the situation?
have had a good relationship previously it is likely the patient
At some time all of us will face such diagnostic challenges. They
will wish to continue under your care. If the patient requests
may be less dramatic or more serious. ‘Could/should this have
referral to a new doctor, facilitate the transfer and offer to
been picked up earlier?’ is an obvious question the patient will put
provide the new doctor with all the details or copies of the
to you – and one which requires an answer. Your response will set
Investigate the cause of the delayed diagnosis.
reaction after such an experience would be to over-investigate every patient presenting with a headache. It is more sensible
to consider your thoughts and decisions in relation to the
management of the patient and develop objective criteria for
the management of common clinical problems.
If the delay was caused or contributed to by a systems error
such as follow-up failure or misﬁ ling of pathology or x-ray reports, tighten up your systems to prevent a recurrence. Avant can advise you about current practice standards for
investigation tracking and follow-up systems.
7. Change and inform. Importantly, while we would
recommend you seek advice from Avant before taking this
step to avoid making any admissions of liability, it is noted that telling the patient about the steps you have taken to
minimise the risk of a repeat of this situation can reassure the
Suggested next steps?
patient that some learning has come from what happened to them.
1. Arrange urgent review. Depending on the urgency of the
8. Notify Avant about the incident. Notify Avant as soon as
diagnosis, arrange to contact the patient for review so that
possible after you become aware of the incident. If you receive
you can inform them of the unexpected ﬁ nding and its
a letter of complaint from the patient or their representative,
implications. A personal telephone call and then a face to
do not answer them without ﬁ rst obtaining advice from Avant.
face conversation is the most appropriate course,rather than delegation to another member of the practice.
9. Consider cancellation of fee. Avoid sending accounts and
reminders where these will inﬂ ame the situation. It is better
2. Explain the situation and the new ﬁ ndings in a face to face
to forego a fee than risk offending the patient. Patients will
discussion. Say how sorry you are about the unexpected news.
often forgive human error but they never forgive error plus
Explain what treatment may be necessary and what it would
perceived greed or arrogance. Not sending a bill is not an
3. Arrange for immediate treatment of the diagnosis.
This may require referral for additional tests and specialist treatment. Preferably arrange these through a phone call with
Avant Mutual Group Limited0746–0610
What if another doctor is responsible for the Things to remember! misdiagnosis and you have made the correct diagnosis?
• Take immediate action to treat and correct errors
1. The steps 1, 2, and 3 above apply.
• Refer immediately for urgent treatment
2. When discussing the diagnosis and its implications, stick
• Maintain interest in the patient’s progress
to the facts. You have one side of the history and as such
• Avoid sending accounts for incorrect treatment
it is better to avoid any implied or stated criticism about the person or persons who may have been responsible for
• Avoid unnecessary or derogatory comments about your
the previous treatment. It is not uncommon for legal claim
or complaint to be pursued by a patient after throw away
• Notify Avant about adverse incidents and complaints –
comments by the receiving doctor, some of which were not
if in doubt about whether to notify, contact us anyway.
intended to be a criticism. Remain professional and objective
1 Terry L Wahls and Peter M Cram (Iowa). The frequency of missed test results
3. If at a later date the patient’s solicitor seeks a report in
and associated treatment delays in a highly computerized health system. BMC
the investigation of a compensation claim, keep the report
objective and avoid criticism unless you are asked to provide an opinion as an expert witness. Contact Avant if you are unsure what is required.
4. As a guide: do what you would have the other doctor do if the
roles were reversed. This might include informing the other doctor of the correct diagnosis and, if the patient agrees, offering to send the patient back to that practitioner so that they have an opportunity to explain. All too often the ﬁ rst inkling of an error or patient dissatisfaction is when a doctor receives a writ or a solicitor’s ‘letter before action’ which proposes negligence proceedings. Genuine care and concern is called for when a patient suffers an adverse outcome of treatment or diagnostic error. Disclaimer
This information is general information relating to legal and/or clinical issues within Australia. It is not intended to be legal advice, nor and should not be considered as a substitute for obtaining personal and speciﬁ c legal and/or other professional advice. Avant Mutual Group Limited and its subsidiaries will not be liable for any loss or damage, however caused (including through negligence), that may be directly or indirectly suffered by you or anyone else in connection with the use of information provided in this forum.
Avant Mutual Group Limited0746–0610
Revista Universidad de Caldas, Enero - Diciembre 2006, págs. 89 - 103 SERPOCAULON A.R. SM. (POLYPODIACEAE L.), UNA REVISIÓN AL GÉNERO DE HELECHOS CON FORMA DE SERPIENTE David Sanín* Abstract Desde 1820 la familia Polypodiaceae, ha sufrido SERPOCAULON A.R. SM. una serie de segregaciones taxonómicas a todo (POLYPODIACEAE), A REVIEW nivel. Actualmente es g
Monday, Sep. 13, 2010 The New Drug Crisis: Addiction by Prescription By Jeffrey Kluger Update Appended: Sept. 17, 2010 It's not easy to find a mother who would look back fondly on the time her son had cancer. But Penny (not her real name) does. Penny lives in Boston, and her son got sick when he was just 13. He struggled with the disease for several years — through the battery