DHSC says dying of cancer is your own fault (apparently)

[wrighty]

I'm not an official spokesman for the DHSC, and these are my own views as a private citizen, albeit 'in the business'.

The way our adversarial legal system works is that each side goes all out for the win, or at least tries to maximally mitigate their losses, and the court decides the final outcome.  If it doesn't happen like that, then one side or the other can claim that they weren't represented properly or whatever, and there can be appeal after appeal.  It's why even the most blatant murderer has a defence lawyer, even when there is no real defence.

In medico-legal cases the claimant will usually go after everyone - I read about this stuff all the time.  I'm not at all talking about this case, but usually if a patient is wronged somehow they will try to sue the GP, the hospital, the GP's receptionist, the secretarial staff...  In return, those being sued will try to deny liability as much as they realistically can and try to attach it to everyone else, including often the claimant.  This can sometimes appear callous and unfair, as is apparent in this case, but it is up to the lawyers and the court to view things rationally rather than emotionally.  It is sometimes the case that the claimant is at fault, and at least partially responsible for their own misfortune - if the hospital being sued didn't explore that possibility in a legal setting they wouldn't be looking after the taxpayers' interests properly.

With regard to referrals - those in receipt will often be getting several per day.  They have to be guided by the information in the letter.  I frequently receive letters marked 'urgent', with clinical information that indicates the problem is not at all urgent.  I may therefore downgrade them as routine.  When waiting lists are too long, and I don't think anyone denies that they weren't in this case, then there is a tendency for the proportion of referrals received marked 'urgent' to increase, in a well meaning attempt to attach priority to an individual patient.  Sometimes it is patients who complain loudly, or are educated and eloquent, or who threaten to contact their MHK, that get sent in as urgent referrals.  It is the responsibility of the receiver to judge all referrals and prioritise them accordingly.  If every one was marked 'urgent' none of them would be.

The first I heard of this case was today in the newspaper.  If I read it correctly, the DHSC's lawyer explored the possibility that the patient was at least partly responsible for the delay in being seen.  This was rejected.  The court did agree however that the GP in question was partly liable - there could be many reasons for this decision, such as not making the reason for urgency apparent, or not telling the patient it was urgent.  I don't know, since I'm not party to the full information.  The DHSC were also deemed responsible, presumably because of the length of the waiting list, or the fact that the receiving consultant downgraded the referral (inexplicably according to the lawyer in the paper)

This is clearly a tragic case where a young man has died as a result of a failure of the system.  As well as the compensation payout undoubtedly due, let's hope the system can change and improve as a result.

[Tibet]

2 minutes ago, wrighty said:

 let's hope the system can change and improve as a result.

We need to do more than hope. We need to demand.

[John Wright]

The newspaper headline is somewhat disingenuous. DHSC admitted liability but suggested

1. The GP should have done more to ensure the patient was seen urgently at Nobles. The Deemster agreed

2. The patient should have kept up pressure to be seen urgently. The Deemster did not agree.

Full facts and judgment here

https://www.judgments.im/content/J1931.htm

[BallaDoc]

I've heard it said that practising as a GP is like digging a trench through a minefield: 99% routine backbreaking work punctuated by the occasional spectacular explosion.  Obviously, this was one of the explosions.  It's so difficult to make sure that all your consultations are perfect in every respect, and that you strike just exactly the right balance between being reassuring - but not too reassuring - and pointing out the dangers - but without being too alarmist.  This was an atypical skin lesion of the sort that most GPs see several times a year.  If I see a skin lesion which is atypical I refer it urgently for removal, just like Dr Evans did, because the only way to be sure what it is is to look at it under a microscope.  Probably 90% are reported as benign.  So, should I tell every patient with a skin lesion which has a 90% probability of being benign "You may have cancer"?  According to this judgement, I should.  Do I, in actual practice, do that?  No, I usually say something like "we should have this removed just in case, but in the vast majority of cases these lesions are benign so don't get too worried about it" which is probably pretty much what Dr Evans said.  But I guess I'm going to have to change my practice from now on.     

[John Wright]

Or your practice system needs to remind you, and your partners, to check that an urgent appointment has, indeed, been made and to follow up.

[BallaDoc]

We do now have a system in place for doing exactly that - the practice manager is notified of all urgent referrals and checks that the hospital has actioned them.  Unfortunately, this system probably wasn't in place in 2011 when the incident occurred. 

[hampsterkahn]

5 minutes ago, John Wright said:

Or your practice system needs to remind you, and your partners, to check that an urgent appointment has, indeed, been made and to follow up.

Apparently, the hospital downgraded the appointment thereby  increasing the waiting time.

Unfortunately, neither  the patient  or the  referring doctor were informed of this.

[John Wright]

12 minutes ago, hampsterkahn said:

Apparently, the hospital downgraded the appointment thereby  increasing the waiting time.

Unfortunately, neither  the patient  or the  referring doctor were informed of this.

The patient didn't know it was urgent. The practice didn't have a follow up system in case of failed urgent referrals, in 2011, according to Balladoc his practice now do have one.

[Aristotle]

14 minutes ago, John Wright said:

The patient didn't know it was urgent. The practice didn't have a follow up system in case of failed urgent referrals, in 2011, according to Balladoc his practice now do have one.

Irrelevant. It's not up to doctors to chase the hospital. It's up to the hospital and its inefficient bureaucracy to not allow the patients of consultants to fall through the net. I hold the hospital completely responsible and reject any suggestion that the GP did anything negligent. It's not his fault the hospital is run by idiots.

[woolley]

51 minutes ago, BallaDoc said:

We do now have a system in place for doing exactly that - the practice manager is notified of all urgent referrals and checks that the hospital has actioned them.  Unfortunately, this system probably wasn't in place in 2011 when the incident occurred. 

It might not be up to the GPs to chase the hospital, as Aristotle asserts, in a perfect system. However with the administration we have at Nobles they absolutely need to, and the system that Balladoc has in place needs to spread to all other practices fast. If it is already in all other practices, either the follow up system doesn't work very well or the hospital administration ignores it.

[Non-Believer]

53 minutes ago, hampsterkahn said:

Apparently, the hospital downgraded the appointment thereby  increasing the waiting time.

This is also practice in the dental side of things, as I discovered for myself recently.

An "urgent" referral to a consultant by my dentist was downgraded to "non-urgent" by the hierachy which I was only advised of a couple of months later when I chased the appointment.

And I'm still waiting, 10 months on. Maybe they were right and it wasn't urgent after all....

[Numbnuts]

I visited my optician in April 2015 and they flagged up a issue . I've history with my eyes . Informed hospital by GP for a urgent appointment and 2 1/2 years later still waiting after having a conversation last year to find out the eye consultant had down graded my appointment . One reason I'm sure ! I'm being cynical now but as years ago they have created a big waiting list so people choose private ...I can't afford it due to illness and unable to work so it's clear it's across the range of treatments . It's so wrong and we didn't pay into to the system for years to be treated like this.. I'm lucky ..this poor guy wasn't !! how many more are dying because of failures in Nobles. 

 

[Dale Cooper FBI]

It is scary how many people I know who have had similar happen to them, all in different hospital departments. Who the hell is in charge up their, Josef Mengele????

[dilligaf]

I wonder sometimes if GPs refer as "urgent" just to get moaning patients off their back, thereby pushing genuine cases further back down the list.

I don't mean in this case as Mr Scott taught both our kids and was a spot on guy, liked by pupils, parents and teachers,( and would not ever be classed as a moaner ) I couldn't believe he died so young. Tragic.

[Numbnuts]

Well in my case I always listen to my doctor and trust his judgement.. Dr Evans is my doctor and has been great with me over the years and have a great relationship with him. He's listened always and took on board my reluctance to take creating meds for depression and anxiety and also has prescribed sleeping pills knowing I'd never abuse them.. Dictirs do there training and fir e most part know far better than a patient. Sadly the system and time allocated often isn't suitable for a all angle covered diagnosis .The issues I dint feel are with GPs and certainly not nursing staff and most consultants. Management and it's bloat is the issue . Not changing anytime soon though it would seem like all departments in government