Ethics

Medical Error
Follow Up Questions/Answers

Can you tell me how you think the consultation went?

o The conversation was difficult because we addressed a hard topic. The patient
was quite rightly distressed and upset at what had happened.
o Everything that needed to be said was said. I was honest with the patient and
ensured he has the information that he needed as well as the consequences of
the error.
o The patient wanted more closure than I could offer in the situation, but I
explained and emphasized how to make a formal complaint.

Would you still need to have the conversation about the drug error if the patient had
come to no harm?
o Yes, I would still need to have that conversation.
o As a doctor, it is vital to be honest with the patient. There is the potential for the
patient to come to harm and even if they do not. It is your responsibility as a
healthcare provider to tell the patient.
o Discuss what would be differently in the future and that it will be reported.

What if the error had not been picked up at this time, but was discovered later and the
patient’s symptoms had completely recovered?
o Again, it is a duty as a doctor to be open and honest in that situation.
o Fortunately, in this circumstance the issue had resolved itself and there was no
danger present, but it is your responsibility to provide support, reassurance and
full disclosure to the patient regarding what has happened.

You have just touched on duties as a doctor. Can you tell me what other guidance exists
to guide doctors about what to do when things go wrong?

o The GMC’s good medical practice guide outlines the duties of a doctor and the
candour required to the patients. It has information on drug errors and what
should be done in those situations.
The patient has left the consultation. Please outline the next steps that you are going to
take.
o Document our conversation carefully; what was said and who was present at the
time.
o Action the next steps, which includes providing the patient with information to
contact PALS, and the chief executive’s contact details.
o Submit an incident report if one had not been done already. In this case, it is a
level 4 incident as the patient did come to harm.
o The system is not a punitive process. As a team and as a clinician we learn from
errors and can see failings in the system. From this, we can improve the system
and protect patients, and protect clinicians from making further errors.
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Is there anything else you might do, or anyone else you would wish to talk to?

o Talk to my consultant about the issue as well as the rest of the team.
o There may be some learning we need to do as a team to make sure that a
situation like that did not happen again.
Finally, who is responsible for filling in the incident form?
o Anyone associated with the incident is responsible.
o Ideally it should be the person who was most aware of the circumstance; but as a
doctor continuing to look after the patient, I could fill it out and ensure that it was
followed up.
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Medical Error

Key Words and Phrases

The candidate explained that she wanted to discuss the recent treatment for his kidney
infection. She also explained about the ringing in the ears as a recognised side effect of
the gentamicin treatment, and that this has come about because the antibiotic was not
dose adjusted according to the levels present in his blood.

This has resulted in a higher than usual level of antibiotic, which has caused some
damage of the inner ear, which are particularly sensitive to this drug.

The GMC good medical practice guidance from 2006 sets out the principles on which
good practice is founded. There is a duty of candor, and the GMC sets out the need
to be open and honest with patients when things go wrong.

The guidance is clear: someone from the healthcare team should speak with the patient,
or someone close to them as soon as possible after the mistake has been identified.

It’s important to note that the duty of candor will still apply if the patient has come to no
apparent harm, eg if the patient has not developed any symptoms of an auto-toxicity,
the condition should still be discussed with him.

Finally, in this case the candidate recognised that some of the patient’s questions
were beyond her scope to deal with as a junior doctor, and that she needed to refer
to other specialties – which in this case were audiologists and ENT.