Defence Organisations need better understanding of GP risk

Guest posting by Dr Aseem Rahman

“You should have told me about that”, she said.

I had no answer. I should have told her about the side effect of the medication I had prescribed. It’s been drummed into us that patients need to make an informed decision with all the facts at their disposal. A perfect synergy of our knowledge and their real life street smarts.

But ALL the facts? Do we discuss every possible side effect of meds? Or every possible complication that might happen during minor surgery? “You might get a papercut from your weighty repeat script Mr Brown.”

Of course we don’t. It would be time consuming and leave patients bewildered. We pick, we choose and we try to get across the important side effects; the ones to look out for and the ones that might matter to a particular patient.

Picking and choosing though, is a gamble. We play the odds and try to tell the patients what they need to know. By not telling them everything, we put ourselves at great risk both professionally and personally. Every script we sign is laced with risk and can lead to a whole range of adverse events. Sometimes the only thing standing between us and a huge pool of potential problems is blind luck. You just have to pick up the MPS Casebook to see all the possible things that could go wrong even when good medicine has been practiced.

I’m not sure that the general population understands the amount of risk that every intervention or non-intervention entails. The disconnect between our perceived and possibly practiced nonchalance and the patient's trust in us is often what leads to complaints and dissatisfaction.

So what can we do to reduce our risk?

Some GPs become ultra-defensive, giving antibiotics for anything vaguely resembling a bacterial infection. If the shit hits the fan they can argue they at least did something. Whilst this helps to get patients out of the room feeling happy, it is terrible practice. It increases future demands, risks possible side effects for the patient and from a global view, greater antibiotic resistance. In essence, it is instant gratification but at the price of long term loss.

Defensive medicine aside, what else can we do? Could we get patients all to sign waivers as they come in the door? Probably not. Patient information leaflets are helpful but don’t medications come with a list of possible side effects already?

GPs have to accept the profession we have chosen comes with inherent risk. We will all have complaints, problems and issues eventually. Jump out of a plane thirty plus times a day and at some point your parachute won’t open.

My bugbear is with the defence unions to whom we all pay huge premiums every month. They should have a better understanding than anyone about the variety and the minutiae of the complaints GPs receive. I’ve never personally heard of them giving any advice other than to cave in, apologise, grovel and try to calm the waters as quickly as possible apart from the cases I've read in their updates. This can feel disheartening - to write a letter of apology when you’ve done nothing to apologise for is incredibly bad for morale.

How much more confident would we be in doing the right thing if we felt we had the full backing of these organisations? Letters would be sent back to patients explaining their unreasonable expectations rather than apologising for any distress. This would lead to decreased demand, better patient understanding of what we do and what we can do. It would lead to us feeling less exposed if we knew we had the defence unions behind us.

For doctor and patient health, this can only be a good thing.

Follow Aseem on Twitter @AseemRahman

References Doctors should not cherry pick what information to give to patients, court rules http://www.bmj.com/content/350/bmj.h1414?ijkey=1ca247ccd575469adb727672723edb2b63a84694&keytype2=tf_ipsecsha Update on the UK law on consent http://www.bmj.com/content/350/bmj.h1481?sso=