دانلود کتاب Avoiding Errors in General Practice

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Avoiding Errors in General Practice Contents Contributors Preface Abbreviations Introduction PART 1 Section 1: The legal structure of negligence A few words about error Medical negligence Negligence Has there been a breach of duty? Causation Damages The limitation period Jurisdictions Learning from system failures – the vincristine example Failure to follow protocols or guidelines Inadequate communication Reference Section 2: Causes of diagnostic errors in general practice and how they can be avoided How do general practitioners reach diagnoses? Initiation of the diagnosis Refinement Defining the final ‘diagnosis’ Where do errors occur in diagnosis? How can we minimize the risks of these errors? References and further reading Section 3: Bayesian reasoning and avoiding diagnostic errors References and further reading Section 4: A potpourri of advice on avoiding errors History and examination The telephone consultation Communication problems When lack of knowledge plays a part The unexpectedly abnormal result The standard of notes Drug errors or prescribing errors Consent Confidentiality Data Protection Act, 1998 Disclosure without consent Caldicott Guardians Conditions that are ‘frequent flyers’ in negligence cases Safety netting References and further reading PART 2 Clinical cases Introduction Case 1 A man with iron deficiency What would you have done with the results? What would you do now? What is your differential diagnosis? Expert opinion Legal comment References and further reading Case 2 When is a headache abrupt? What would you have done? What would you do now? What is your differential diagnosis? Do you think their claim will succeed? Expert opinion Legal comment References and further reading Case 3 A woman with chest pain What other information would you obtain? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert opinion Legal comment References and further reading Case 4 A dizzy man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Case 5 Rectal bleeding in a pregnant woman If you had been her GP what would you have done? Would you have done anything differently? Expert opinion Legal comment References and further reading Case 6 A pulled calf muscle What are the clinical features that you would consider discriminatory when assessing a possible DVT? What would you do now? Do you think her claim will succeed? Expert opinion Legal comment References and further reading Case 7 A woman with hemiplegic migraine What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Online resources Case 8 Irritable bowel syndrome after sickness in Goa What would be your differential diagnosis? What would you have done differently? Expert opinion Legal comment References and further reading Case 9 A young man with back pain Do you think his claim will succeed? Expert opinion Should Dr Mitchell have insisted on admission? Should Dr Murphy have sought admission? Legal comment References and further reading Case 10 Irregular intermenstrual bleeding in a woman on the pill What would you do? Would you have done anything differently? Expert opinion Legal comment References and further reading Case 11 A boy with a limp What is the differential diagnosis and what would you do now? Do you agree with the diagnosis? Would you have managed the case differently? Do you think his claim will succeed? Expert opinion Legal comment References and further reading Case 12 A runner with a cough What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert opinion Legal comment Further reading Case 13 A woman with classical migraine What would you do now? What bits of information would you want to elicit? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment Further reading Case 14 A young woman with diarrhoea and vomiting Why was the diagnosis of appendicitis missed? Expert comment Legal comment References and further reading Case 15 Ill-fitting dentures in an elderly man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 16 Back pain in a middle-aged woman What would you do now? Are any particular features on examination likely to be helpful? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 17 Cellulitis in a man’s foot Would you have done anything differently? Would this result have reassured you? Expert opinion Legal comment References and further reading Case 18 A flare-up of ulcerative colitis What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References Case 19 A woman with a skin lump on her leg Do you think a claim against Dr Welch will succeed? Expert comment Legal comment References and further reading Case 20 A woman with microscopic haematuria What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References Case 21 A limping young girl What would you do now? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 22 A builder tripping over his feet What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 23 An anxious young woman with hyperventilation What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment What went wrong in this case? Legal comment Further reading and references Case 24 A slightly raised AST in an Asian woman What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 25 Cough and fever in a 42-year-old accountant Would you have done anything else? Do you think his claim will succeed? Expert comment Legal comment References Case 26 Lost prescription: Benzodiazepine addiction What options were open to the GP? Should she speak to the police? Expert comment Legal comment Further reading Case 27 A febrile baby What features would you have specifically noted? Would you have done anything differently? Do you think his claim will succeed? Expert comment Legal comment Further reading and references Case 28 A limping elderly woman after a fall Would you have done anything differently? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 29 Indigestion in a stressed executive What would you do now? What would be your differential diagnosis have been and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment References and further reading Case 30 A hoped-for pregnancy What would you do now? What would be your differential diagnosis and what would you do? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 31 A breast lump that disappears What would you do now? Do you think her claim will succeed? Expert comment Legal comment References Case 32 Fever and cough after an ankle fusion Would you have done anything differently? Do you think the claim will succeed? Expert comment Legal comment References Case 33 Urinary problem in a welder What would you do now? Do you think his claim will succeed? Expert comment Legal comment References Case 34 A hypertensive 38-year-old woman What would you do now? Expert comment Legal comment References Case 35 A swollen lip in a 56-year-old man What would you do now? What would be your differential diagnosis and how would you discriminate between them? Do you think his claim will succeed? Expert comment Legal comment Reference Case 36 A woman with fatigue and weight gain What would you do now? Would you have done the same? Expert comment Legal comment References Case 37 A woman told off for ignoring her friends What would you do now? What would be your differential diagnosis and how would you discriminate between them? Would you have done anything else? Do you think the claim will succeed? Expert comment Legal comment Further reading and references Case 38 A man with a headache: Swine flu or meningitis? What would you do now? Was it reasonable to diagnosis swine flu and authorize Tamiflu? What would be your differential diagnosis and how would you discriminate between them? Can Dr Craig be criticized for his initial diagnosis of flu? Headache is relatively common with influenza. How does one avoid admitting everyone with flu? Expert comment Legal comment References and further reading Case 39 A woman suffering dizziness Was there anything else you would have checked? What would be your differential diagnosis and what would you have done? Do you think her claim will succeed? Expert comment Legal comment References and further reading Case 40 A middle-aged man with an ankle injury What other information would you obtain in a case such as this? Do you think a claim against the GP will succeed? Expert comment Legal comment Further reading PART 3 Investigating and dealing with errors 1 Introduction 2 How errors and their recurrence are prevented in primary care Guidelines and protocols Audit Appraisals Complaints management Significant Event Analysis 3 The role of the Primary Care Trusts Performers’ Lists 4 Other investigations National Clinical Assessment Service (NCAS) Partnership issues arising from errors The Care Quality Commission 5 Legal advice – where to get it and how to pay Medical Defence Organizations 6 External inquiries The Health Service Ombudsman Negligence claims and the litigation process Coroner’s Court Fatal Accident Inquiries Criminal matters Public inquiry General Medical Council in practice An example from general practice The GMC in future 7 The role of the doctor Witness statements Formal requirements Content Presenting oral evidence 8 Emotional repercussions 9 Conclusion Reference Index