A cold reply - medical case study

...the patient is unhappy that the doctor provided a telephone consultation rather than a home visit...

BACKGROUND: MRS C, 53, has been unwell for several days, feeling weak and vomiting frequently. She has long-standing health problems, including a history of cancer, and has attended a number of hospital appointments over the previous 12 months. Fearing her health may be deteriorating, her husband calls her GP practice to request a home visit.

He speaks to his wife’s regular GP, Dr M, who provides a phone consultation instead of a home visit. He writes a prescription for Mrs C with an increased dose of her existing medication for pick-up at the practice. Over the next few weeks Mrs C’s condition does not improve and Mr C makes further calls to the practice. Dr M continues to consult by phone but on two occasions the duty doctor makes a home visit.

Initially Mrs C appears to be responding well to medication but on the second visit she is referred to hospital. Her condition deteriorates further and she dies two weeks later.

The practice receives a formal complaint from Mr C regarding the standard of treatment his wife received in the months before her death. In particular, he is angry that Dr M ignored his requests for a home visit and insisted on telephone consultations.

The practice responds by detailing the numerous contacts Mrs C had with the practice shortly before her death, concluding that Dr M acted appropriately in all instances. Mr C is unhappy and forwards his complaint to the health service ombudsman.

ANALYSIS/OUTCOME: Dr M seeks advice from MDDUS on how to respond to the ombudsman. An adviser explains that the practice’s initial response to Mr C’s complaint appears purely factual and lacking in empathy and did not address the specific concerns regarding the standard of care provided. She helps Dr M draft a suitable response that explains their clinical decision-making, including why home visits were denied. She advises the letter should also express concern at the factual nature of the original response and explain that the practice will ensure future complaint responses fully address the concerns stated. It should also mention that the practice held a significant event analysis in order to learn from the mistakes made.

The ombudsman identifies a number of failings in Dr M’s clinical decision-making and in the practice’s complaint handling but they accept the practice have taken steps to address these issues. The practice is advised to apologise in writing to Mr C and the matter is taken no further.

KEY POINTS

• Ensure complaint responses address the complainant’s concerns and are not simply a list of factual statements about treatment provided.

• Seek advice before responding to patient complaints as an ill-conceived response risks further difficulties with the health service ombudsman