Registrar pre teaching session worksheet
>click here for printable version<General Practice is about good practice with the aim of achieving the best patient outcomes. It also helps avoid litigation. Mistakes do happen and patients do sue (sometimes) whether a mistake is made or not. Whether you have done the right thing or the wrong thing you will receive the same high level of non-judgmental support.
The focus of this teaching module is how good clinical practice supported by good systems will minimize the risk of being sued.
Good medico-legal risk management is not about knowing the detail of the law; rather it is about reasonable practice based on sound principles.
This module involves
- Identification by the Registrar of three clinical encounters that have presented different types of risk of serious misdiagnosis or adverse outcome. The Registrar and Supervisor should agree on these three encounters before further work is done.
You may wish to refer to the list of clinical areas with an increased risk of adverse outcomes from the RACGP [standard T17].
Another way of flagging such potential encounters, is to identify any consultations that you have worried about after work.
- A review by the Registrar of these three clinical encounters using a list of questions and discussion points.
- Subsequent discussion between the Registrar and the Supervisor of the cases and the reflections of the Registrar.
Together they need to develop some practical rules for ensuring:
- Diagnosis, management and follow up are consistent with current standards.
- There is good communication with the patient and with colleagues
- There is good record keeping
The point here is that the best outcome for patients also minimizes the risk of being sued.
Activity
After selecting the 3 patient encounters and read through your notes to refresh your memory. For each case please consider the following questions:
- What are the issues here? What was the (potential) misdiagnosis or adverse outcome?
- Do you think you made a mistake or could have made a mistake? Would your peers have acted in the same way?
- Do you think your case notes were adequate?
- Were there any communication problems either during the consultation or subsequently?
- Are there any clinical rules that you will always use following this case?
- What Practice systems were relevant? Were they adequate?
- Was there a bad outcome? How did you deal with it?
- Who do you get your advice from and when?
- What factors would affect whether a misdiagnosis or adverse outcome could result in a claim for compensation?
- If you had this case over again, would you do anything differently?
Make some notes around these questions and bring them along with the case notes to your next tutorial with your Supervisor.