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CASEBOOKDIVERTED BY THE DIAGNOSIS

Professional support and expert advice from your leading medicolegal journal

Inside...

YOUR TEAM, THERE FOR YOUMeet your local medicolegal team

UNDERSTANDING FATAL ACCIDENT INQUIRIESRead our case study

OVER TO YOUThe place to debate hot topics

REVIEWSBook, film, app read our reviews

HOW A HOSPITAL ASSESSMENT MISLED A GP PAGE 16

VOLU

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MPS GENERAL PRACTICE CONFERENCE 2015MAKING PRACTICE SAFE

MPS MORE THAN DEFENCE

The Medical Protection Society Limited A company limited by guarantee. Registered in England No. 36142 at 33 Cavendish Square, London W1G 0PS, UK.MPS is not an insurance company. All the benefi ts of membership of MPS are discretionary as set out in the Memorandum and Articles of Association. 1680: 04/15

EARNCPD

FRIDAY 19 JUNE 2015, LONDON

Our one day conference is ideal for GPs and the primary care team who want to focus on making practice safer and improve on patient safety

95 for GPs and 50 for GP Registrars, Practice Managers, Practice Nurses and Practice Sta

PROGRAMME Managing Challenging Interactions with Patients Human Factors and Systems Errors Reporting Incidents Personal Impact of a Claim and Complaint

PLUS WORKSHOPS ON Medicolegal Dilemmas Safe Prescribing Infection Control Managing Confl ict and Aggression Complaints: How Does Your Practice Measure Up?

FIND OUT MOREwww.medicalprotection.org/gp-conference

99%of delegates would recommend this conference to a colleague

An enjoyable informative day with learning points for both me and my practice allowing us to reduce risk and enhance our safety

1680 GP Conference A4 advert.indd 1 23/04/2015 16:26

CASE REPORTS

11 Pulled in all directions

12 Missed critical limb ischaemia

13 Cumulative errors

14 Too much oxygen

15 A problem with polyps

16 Diverted by the diagnosis

18 A malignant lesion

19 Fatal condition

20 A persistent headache

21 The swollen knee

22 Stroke after carotid surgery

FEATURES

05 MPS Scotland: meet the team

Meet your medicolegal team in Scotland, and find out what individual expertise is available to you as a member of MPS.

08 Fatal Accident Inquiries and the Procurator Fiscal

The Fatal Accident Inquiry and the role of the Procurator Fiscal is a process unique to Scotland. We outline a case and provide guidance.

FACTS AND OPINION

04 WelcomeDr Nick Clements, editor-in-chief of Casebook, comments on some topical issues affecting healthcare.

10 From the case filesMelanie Rowles, head of claims management at MPS, looks at what can be learned from this editions collection of case reports.

Every issue...

23 Over to youA sounding board for you, the reader what did you think about the last issue of Casebook? All comments and suggestions welcome.

26 ReviewsIn this issue Dr Sam Dawson reviews Being Mortal by Atul Gawande, while Dr Anand Naranbhai looks at Postmortem: The Doctor Who Walked Away by Maria Phalime.

WHATS INSIDE

Get the most from your membership

Visit our website for publications, news, events and other information: www.medicalprotection.org

Follow our tweets at: www.twitter.com/MPSdoctors

Top tips in the palm of your hand download the free MPS Advice app on the App Store or Google Play

Opinions expressed herein are those of the authors. Pictures should not be relied upon as accurate representations of clinical situations. The Medical Protection Society Limited 2015. All rights are reserved.

ISSN 2056 4449

Casebook is designed and produced twice a year by the Communications Department of the Medical Protection Society (MPS). Regional editions of each issue are mailed to all MPS members worldwide.

GLOBE (logo) (series of 6) is a registered UK trade mark in the name of The Medical Protection Society Limited.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary, as set out in the Memorandum and Articles of Association.

Cover: KatarzynaBialasiewicz/iStockphoto/thinkstockphotos.co.uk

http://www.medicalprotection.orghttp://www.twitter.com/MPSdoctors

WELCOMEDr Nick ClementsEDITOR-IN-CHIEF

edical matters, unsurprisingly, continue to feature heavily in the headlines and the media in general. There seems to be an endless appetite

among the public for such stories, whether they are announcing the arrival of new and better treatments or procedures, or reporting shortfalls, errors or even scandals. Politicians frequently feel obliged to step in, but their attempts to remedy things dont always have the desired result.

Inevitably this is felt by you on the wards or in your consulting rooms, with increasing patient expectations in the form of unrealistic demands or a raft of self-researched information from the internet. This can make for some challenging situations, at a time when workloads grow in intensity, perhaps due to budgetary cutbacks or other local factors.

It continues to be an important time to be part of an organisation like MPS. We work in partnership with you to protect and support your career at every stage, and this work takes many forms, beyond the litigation work that we are more traditionally associated with. This includes an extensive range of educational products such as online learning, workshops and seminars, as well as continuous consultative work with governments and policy-makers worldwide. The latter is often behind the scenes and often not highly-publicised, but you can be reassured that our specialist teams are fighting hard to safeguard your interests.

Many of you got in touch with us following the last edition of Casebook, regarding our cover story on the case of Beth Bowen. While the emotional reaction from a number of correspondents was not surprising, I was heartened by the way the article made everyone think about their own approach to communication, openness and consent. Anger at the treatment of the Bowen family was palpable in some of your letters, and if this deeply tragic case results in reflection and changes in culture and practice, then something positive will have been achieved.

We have published a short response to this correspondence in our Over to you section on page 23. I hope you find this edition of Casebook an equally thought-provoking one and, as ever, I am keen to hear your feedback.

M

MPS SCOTLAND: MEET THE TEAMAs an MPS member in Scotland, you have access to a wide range of specialist support and advice. Based in our Edinburgh office, the MPS team has extensive experience of Scotlands medicolegal landscape find out how they are working hard on your behalf

In 2009, MPS established its base of specialist Scottish medicolegal services in our office on George Street, Edinburgh. Since then the team has grown to over 30 members of staff working together to support members practising in Scotland.

MPS Scotland also provides:

Risk management and performance improvement: Each year we deliver up to 40 teaching sessions and lectures for hospital doctors and general practice teams across Scotland.

Support for your development: You have access to a range of CPD-approved education and risk management resources in Scotland. Each year, MPS runs up to 20 workshops and seminars in Scotland, including half-day risk management workshops and full-day practice management seminars.

Please address all correspondence to:

Casebook editorMedical Protection SocietyVictoria House 2-3 Victoria Place Leeds LS11 5AE United Kingdom

casebook@medicalprotection.org

EDITORIAL TEAM

Dr Nick Clements EDITOR-IN-CHIEF

Sara Dawson DEPUTY EDITOR

Gareth Gillespie EDITOR

CASE REPORT WRITERS

Dr John Adams Dr Mike Greenberg

Dr Dudley Bush Dr Paul Heslin

Mr Sam Dresner Dr Gerard McKeague

Mr David DSouza Dr Janet Page

Dr Anna Fox Dr Ellen Welch

PRODUCTIONPhilip Walker, Production managerEmma Senior, Senior designerDante Marcuccio, DesignerAllison Forbes, Assistant designer

EDITORIAL BOARDAntoinette Coltsmann, Dr Marika Davies, Professor Jonathan Hardman, Dr Muiris Houston, Dr Graham Howarth, Mark Jordan, Mr Goldie Khera, Dr Sonya McCullough, Dr Gordon McDavid, Shelley McNicol, Julie Price, Dr Ewen Ross, Dr Ming-Keng Teoh

Dr Gordon McDavid EDITORIAL CONSULTANT

C

ate Gillon

5CASEBOOK | VOLUME 23 ISSUE 1 | MAY 2015 | www.medicalprotection.org

FEATURE

mailto:casebook%40medicalprotection.org?subject=

The team in Edinburgh features specialists in their field, with many years combined medicolegal experience. Here a small selection of the team tells Casebook how their expertise can help support and guide MPS members in Scotland.

graduated with MBChB from Glasgow University. I worked as a doctor in various hospitals

around the west of Scotland, eventually specialising in general and respiratory medicine. Eventually I decided to move into full-time medicolegal work and joined MPS three and a half years ago.

The Scottish caseload is unique in that much of the law and terminology is different from the rest of the UK. Having an office based in the centre of Edinburgh not only makes it easier for MPS members to access our support, but it also enables us to retain local specialist knowledge of relevant rules and regulations, and to stay informed of any changes.

The role of a medicolegal adviser is qu