Medical Defence Organisations Research Articles

Health impairment allegations against doctors: Qualitative analysis and insights for Australian general practitioners.

A thematic analysis was conducted of semistructured interviews with 21 doctor-patients and four doctors' health experts. Doctor-patient participants had experienced a past or family psychiatric history, personal loss or trauma, access to drugs at work, workplace stress or recent patient death or suicide. Many avoided seeking care and were significantly unwell when notified to medical regulators. Regulatory processes caused distress, symptom relapse, suicidality, financial pressures and work difficulties. Doctor-patient participants sought assistance from GPs, doctors' health services, medical defence organisations, recovery groups and benevolent associations. When treating doctor-patients, GPs can consider targeted mental health screening, openly discussing mandatory reporting obligations and accessing advice from their medical defence organisation or local doctors' health service. Trust and clear communication benefits doctor-patients and the wider communities they serve.

Doctors' understanding of consent law.

Obtaining informed consent is an important responsibility of all doctors and is a major component of their day-to-day practice. However, little is known regarding practising doctors' understanding of consent in relation to medical law. To gain insights into current doctors' understanding of the legal requisites that underpin the consent of patients to medical procedures in Australia. A cross-sectional survey of Western Australian medical practitioners was conducted. A 15-question online questionnaire (SurveyMonkey, USA) was developed and distributed to Western Australia medical practitioners via social media, hospital-based Junior doctor society pages and through the email accounts of practitioners registered with MDA National - a large medical defence organisation. Doctors were questioned on their understanding of medicolegal responsibilities, informed consent practice and knowledge of a historically significant Australian medicolegal case (Rogers v Whitaker, 1992). A total of 172 responses was received during the survey period. The respondents came from various levels of seniority and from a variety of subspecialist areas. The survey demonstrated that among the respondents, the understanding of their medicolegal responsibilities around the issues of informed consent was deficient. Only 31% of respondents were aware that it is a court of law that defines the reasonable standard of care in relation to obtaining informed consent. Less than half of the respondents (48%) were aware of the High Court of Australia's definition by which the standard of reasonable care is defined. The results from our survey suggest that there is a requirement to enhance the education of medical practitioners to meet the medicolegal requirements and optimise consent.

The Imbalance in Medico-Legal Cover Awareness and Uptake Between Overseas Junior Doctors and Local Graduates in the NHS

BackgroundRecent reports showed that overseas doctors were more likely than UK graduates to be referred by their employers to the General Medical Council (GMC). We investigated the trend of medico-legal insurance awareness and uptake of medical defence organisations (MDOs) by junior doctors and to examine if there is a difference between overseas and UK graduates.MethodsOnline questionnaire survey sent to junior doctors within the Yorkshire and Humber Deanery. Data regarding year of graduation, country of origin of primary medical qualification, year of starting work in the National Health Service (NHS) and date of joining an MDO were collected. Participant-identifiable information was not collected.ResultsA total of 202 junior doctors completed the survey: 153 (76%) UK graduates and 49 (24%) overseas. Overseas doctors were less likely to know about MDO compared to UK graduates prior to working in the NHS (13 [26.5%] vs. 146 [95.4%]; p < 0.0001). At the time of starting practice, MDO uptake was still significantly lower amongst overseas graduates (4 [8.2%] vs. 144 [94.1%]; p < 0.0001). Uptake by overseas doctors increased after starting work to 33 (67.3%). However, despite improvement in MDO uptake, a significant number of overseas doctors still did not have independent cover compared with UK graduates (16 [32.7%] vs. 3 [2%]; p < 0.0001).ConclusionsOverseas graduates joining the NHS are still less likely to be aware of the requirement of adequate medico-legal cover and are less likely to join an MDO compared with UK graduates. Healthcare providers and regulators should work to decrease the existing gap and increase awareness amongst newly arrived overseas doctors.

Is the end nigh?

A year after its launch, the results of the Department of Health &amp; Social Care’s (DHSC) consultation on ‘appropriate clinical negligence cover’ are still widely anticipated. In this article, we explore the benefits and disadvantages of regulated and discretionary indemnity cover as understood by the DHSC, the medical defence organisations (MDOs), insurance brokers and underwriters. We also turn to surgeons and clinicians with private practices to ask what they think about the current arrangements. Reforms to medical indemnity insurance forecast the passing of the UK's long-established medical defence and protection organisations.

Complaints: traditional and modern considerations

What follows is obviously based on UK practices but, no doubt, similar circumstances apply elsewhere. Informal complaints, ‘dissatisfactions’, can often be resolved by prompt face-to-face explanations with detailed listening and...

Medical defence organisations and quality improvement in maternity care.

Medical defence organisations and quality improvement in maternity care.

Patient consent in the post-Montgomery era: A national multi-speciality prospective study

BackgroundThe Montgomery ruling has had a wide-ranging impact on the consent process and has been the subject of new guidelines by bodies, including the Royal College of Surgeons (RCSEng). This is the first study to examine the current standard of consent for surgical procedures at a national level. MethodA national collaborative research model was used, with prospective data collection performed across hospitals in Scotland. Variables associated with the consent process were audited across three surgical specialities (general surgery, urology and orthopaedics) and measured against standards set by RCSEng, the Scottish Public Services Ombudsman and medical defence organisations. ResultsA total of 289 cases were identified from 12 hospitals. The majority of patients were reviewed by a consultant surgeon in clinic (79.9%) or on the day of surgery (55.4%). The clinic consent rate was 27.0%, while a copy of the documented discussion was only provided to 4.2% of patients. On the day of surgery, the benefits, risks and alternatives to the planned procedure were discussed in less than half of cases. This rate was similar across different clinician grades, while marked variation was seen across hospitals. ConclusionIn this prospective multi-centre study we have demonstrated wide variation in the consent processes in many surgical specialities across Scotland. Following the Montgomery ruling, we have demonstrated the current consent process in elective surgery is likely to be substandard, and may require additional steps to be taken by clinicians to ensure patients are fully informed to make decisions regarding their treatment.

What to do when the letter arrives

Multimillion pound medical negligence claims are no longer a rarity, but receiving a solicitor’s letter can feel like a shocking blow. Although so much seems to be at stake, MDU claims handler Dr John Dale-Skinner recommends some ways in which consultant orthopaedic surgeons can help themselves. In recent years, the Medical Defence Union (MDU) has seen a disturbing rise in the number of high value claims against consultant members, including our highest settled claim to date: £9.2 million in compensation and legal costs for a patient left tetraplegic after spinal surgery. In 1995, the MDU settled one medical negligence claim for over £1 million. By 2015, there were 12 such claims. Within the private sector, orthopaedic specialists are at greater risk of a claim than, say, ophthalmologists or general surgeons. Despite what some commentators might suggest, the increase in high value claims and the rise in negligence claims generally are not caused by a fall in clinical standards. In fact, during 2015 the MDU successfully defended 80% of claims brought against our medical members. If you are unfortunate enough to receive a claim, here are the five most effective ways that you can help us to help you: 1. Notify your Medical Defence Organisation The first you are likely to know about a claim is when you receive a solicitor’s letter which sets out the allegations and is accompanied by the patient’s signed consent to release their records. This is known as a Letter Before Action and can be upsetting but do not be tempted to write to the solicitors or contact the patient directly to refute the allegations. Doing so can make the claim more difficult to manage. Instead, notify your Medical Defence Organisation (MDO) straight away; they will guide you throughout the process. 2. Get your paperwork in …

The pitfalls of prescribing for family and friends.

In most of Australia there is no legislation prohibiting medical practitioners from prescribing for family and friends. In South Australia it is prohibited to prescribe Schedule 8 drugs for family members unless it is a verifiable emergency. The Medical Board of Australia states medical practitioners should avoid providing medical care to anyone with whom they have a close personal relationship. Medical defence organisations may exclude treatment of family members from doctors' insurance cover. Think very carefully before you prescribe for family and friends. It is only considered ethically and professionally appropriate to prescribe in exceptional circumstances, and there are potential risks to you and your family member or friend if you do.

GMC should audit effects of its investigations on doctors, report recommends

The General Medical Council should audit how its investigations affect doctors’ lives and careers, a report of a roundtable event has concluded. A report of the event, which took place in September, was shared with the event’s participants in December 2014 and has been seen by BMJ Careers. The report recommended that the GMC begin a “review of practices and procedures” and take appropriate action as a result of the review’s findings. It said that the GMC should “audit the impact of investigation on individual doctors and include how sanctions affect a doctor’s career.” The event, called “Regulation, respect, and healthcare practitioners,” was organised by Clare Gerada, medical director of the Practitioner Health Programme, a London based, confidential health service for doctors and dentists. Event participants included doctors, lawyers, academics, and representatives of medical defence organisations and regulatory bodies. The …

What should GPs be doing about chaperones?

Trust remains the cornerstone of the relationship between a GP and patient. If a GP should use words or actions of a sexual nature with a patient in the context of the consultation, a professional boundary may have been crossed and the inherent trust between doctor and patient may have been compromised.1 In this unique clinical environment, both patient and GP are vulnerable. Failure to address this issue can have life-changing repercussions for one or both parties. The use of medical chaperones (or the presence of a third party as observer) during clinical examinations is important whether one practises as a GP, specialist, medical student, nurse, or other member of the practice staff (for example, physiotherapist) who examines patients. This is regularly highlighted in tabloids and medical magazines where health practitioners have acted inappropriately, and minimising this risk to patients is an important component of good medical practice. The offer of a chaperone, as advocated by the General Medical Council and various medical defence organisations in the UK and elsewhere, goes some way to reduce this risk. As secondary functions, the role of a chaperone may include providing comfort to patients and protection for doctors from false allegations.2 The accompanying commentary by Rob Hendry on the paper by Wai et al is probably a more pragmatic and succinct approach for GPs.3 The concerns surrounding medical chaperones have been debated elsewhere over nearly three decades now and are not the purpose of this commentary.2,4,5 Rather, what should GPs …

GP surgeons: what are they? An audit of GP surgeons in South Australia

In many parts of Australia where there is no access to local specialist services, procedural services are provided by local GPs. Within the range of procedural skills offered, a small group of GPs is able to provide surgery. Unlike other procedural areas, there remains no defined training or assessment pathway for GP surgeons. Support from specialist colleagues is variable and continuing education arbitrary. The result is a somewhat ill-defined group that is poorly understood by credentialing bodies, government, medical defence organisations and training colleges. This study aims to describe the scope of practice, initial training and ongoing support and education for GP surgeons currently practising in South Australia. Seventeen semistructured interviews were undertaken with self-identified GP surgeons (74% response rate). Areas explored included demographics, scope of practice, initial training and ongoing support and education. Content and thematic analysis was used to identify common responses and themes. The amount of initial training varied among participants, with a mean duration of training of 20 months. Initial assessment of competency for the majority of participants was assessment by a supervisor (10/17). The most common procedures undertaken were caesarean sections (94% of participants) and grafts and flaps (94%). The most common continuing professional development was clinical attachments (27%) and assisting visiting specialists or colleagues (17%). This study demonstrates a wide variation in training, scope of practice and continuing education for GPs performing surgery, highlighting the effects of a self-regulated system. There is a trend towards an increased level of training; however, engagement in continuing education remains low. Further work is needed to define this group, to enable successful planning of future training and education to support this group in rural areas.

Medical defence organisations

Medical defence organisations

Can the use of quality assurance tools reduce the impact of surgical complications on the well‐being of obstetricians and gynaecologists in Australia and New Zealand?

While adverse events primarily affect the patient, surgeons involved can also experience considerable distress. The aim of the survey was to assess the impact of complications on the day-to-day life, work and health of Australian and New Zealand obstetricians and gynaecologists and to evaluate existing support systems and coping strategies. A 43-question survey on self-assessment, quality assurance (QA) tools, impact of complications on individuals' health and relationships, and support available was emailed to fellows, trainees, subspecialists and subspecialty trainees of the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG). We collected 606 responses from a target population of 2296 (response rate 26.3%). When complications occur, sleep was affected of 80%, family and social relationships of 55% and physical health of 48% of respondents. The major sources of support were from colleagues (83%), family (82%) and medical defence organisations (73%), with professional bodies perceived as providing least support. Nearly 80% of respondents felt the need to talk to someone they trust during times of complications. Overall, 100% of respondents used at least one QA tool (62% used two, 26% three and 9% four QA strategies). There were significant differences between respondent groups in use of the QA tools. Surgical complications have a significant impact on the well-being of Australian and New Zealand obstetricians and gynaecologists. Existing support comes from colleagues and family, but structured, unbiased support for surgeons from a professional source is urgently warranted.

Suggestions for improving guideline utility and trustworthiness

Clinical practice guideline (CPG) panels are expected to abide by standards that ensure their processes are multidisciplinary, systematic and unbiased.1 Unfortunately, many CPGs fail to satisfy these standards. Only a...

Analysis of the latest Austroads guidelines for fitness to drive as promulgated in March 2012

After 9 years, Austroads has published new guidelines for fitness to drive. The guidelines have a preamble, which includes a legal disclaimer denying any culpability for those who designed the guidelines. They also warn of the legal responsibility for health professionals to satisfy their obligations, the need to be current with both relevant medical and legal expectations and if in doubt to seek guidance from Medical Defence Organisations. The guidelines are divided into Parts A and B, with A providing broad overview and background information while B deals with specific entities, such as blackouts, epilepsy or sleep disorders. This paper examines the guidelines and offers an appraisal of their content, their relevance to health practitioners and an assessment of their role in assisting to improve road safety.

‘Don’t shoot the messenger’: the problem of whistleblowing in general practice

On the 9 June 2010 the then Secretary of State for Health, Andrew Lansley, announced a full public inquiry into the role of the commissioning, supervisory, and regulatory bodies in the monitoring of Mid Staffordshire NHS Foundation Trust. The Inquiry was chaired by Robert Francis QC, who has made recommendations to the Secretary of State based on the lessons learned from the failures of care provided by the Trust between January 2005 and March 2009.1 The Inquiry heard oral evidence from six GPs whose surgeries are situated within the Trust catchment area. This focused largely on the extent to which the GPs were aware of problems at the Trust. The Francis Report raises a number of serious issues about NHS ’whistleblowing’ and identifies failures in the application of current whistleblowing policies. The NHS, and GPs in particular, face unique problems in whistleblowing. a. ‘The GMC guidance states that GPs have a duty to raise concerns. When I contacted the GMC, they recommended that I contact the BMA. The BMA recommended that I contact my [medical defence organisation] MDO. My MDO recommended that I contact the BMA’ All doctors have a duty to act when they believe patients’ safety is at risk or that patients’ care or dignity is being compromised.2 This paper defines ‘raising a concern’ as doing so through the normal internal structures of accountability and ‘blowing the whistle’ as highlighting a concern to individuals outside of these structures, often externally, and normally after failing to successfully raise the issue through the expected internal routes. When a GP decides to act as a ‘whistleblower’, for example because of concerns about the patient care provided by a GP colleague, he or she may have an additional challenge because in a practice partnership professional, financial, and social interdependency coincide; …

Should a Psychiatrist Give Legal Advice on Cosmetic Genital Surgery?

The UK Female Genital Mutilation (FGM) Act 2003 states that‘‘A person is guilty of an offence if he excises, infibulates or otherwise mutilates the whole or any part of a girl’s [or woman’s] labia majora, labia minora or clitoris.’’ In a case report about a woman undergoing clitoridectomy following a previous unsatisfactory cosmetic labiaplasty, Veale and Daniels (2012) noted that ‘‘Anatomically, there is little to distinguish FGM from some of the procedures involved in carrying out legitimate surgery.’’This is correct, but begs the question as to who decides the legitimacy of such surgery. TheAct states that‘‘no offence iscommittedbyanapproved person who performs a surgical operation on a girl which is necessary for her physical or mental health’’but also that‘‘...it is immaterial whether she or any other person believes that the operation is required as a matter of custom or ritual.’’ Is cosmetic surgery as performed in clinics such as Restore UK (http://www.gynecosmetics.com/) really necessary for mental health or are we witnessing the emergence of new culturally determined customs and rituals? More pertinently, will patient consent protect surgeons from criticism? Veale and Daniels (2012) stated that‘‘The role of the mental health specialist is to assess and advise the surgeon on the wisdom and legitimacy of carrying out the proposed procedure.’’ Veale remained ‘‘very uncomfortable’’ about advising a go-ahead (presumably thinking it unwise). He admits that perhaps he should have spoken to the husband or obtained an ethical opinion (Veale, 2012). He does not state whether he had any conflict of interest with respect to payment for the consultation or whether he took legal advice. Nevertheless, ‘‘The advice [he gave] to her surgeon was that a clitoridectomy could be exempted from the Female Genital Mutilation Act for cosmetic reasons. The rationale was that, if labiaplasty can be done for cosmetic reasons for perceived abnormality, then there was no reason that clitoridectomy could not be done on the same grounds’’ (Veale & Daniels, 2012, p. 728). This is simply wrong. Doctors do not decide legitimacy. It is a matter for the Courts. Did the authors, reviewers or Editor consider contacting a Medical Defence Organization, the General Medical Council or the police? It seems rash to advise patients or publish articles regarding a potential serious criminal offence without properly investigating the legality.

Patient complaints are the top reason why doctors seek medicolegal advice

Complaints from patients were the most common reason for doctors seeking medicolegal advice last year, a medical defence organisation has said. An analysis of contacts with members by the Medical and Dental Defence Union of Scotland (MDDUS) showed that in 2011 doctors telephoned, …

Relaxing boundary rules could affect GPs’ ability to care for patients

Government proposals to allow patients to register with a general practice remote from their home could affect the practice’s accountability for its patients and its ability to provide continuity of care, a medical defence organisation has warned. The government is looking at relaxing rules on general practice boundaries to enable patients to see a GP at a practice further away from where they live, because for many it would be more convenient to have a consultation near their place of work or where their children are at school. A year long pilot scheme to test the feasibility of the plan is due to start …