P Bark

The impact of litigation on obstetricians and gynaecologists

SummarySeventy-five per cent of senior obstetricians and gynaecologists (47/63) in the North Thames (West) Region had been involved in litigation. They reported that difficulties with professional relationships and team working is at the heart of much injury to patients, particularly supervision of junior staff and communication between staff and patients. Other common concerns were inadequate record keeping, the use of locums and transient staff and out-of-date equipment. There was little indication of defensive medicine but the effects of litigation on individual doctors was disturbing in a proportion of cases. Many felt distressed and personally attacked, some considered giving up medicine. The human costs, often overshadowed by the concern with financial costs, are great. Clinical risk management strategies must be developed to counter the risk factors identified. Training in communication skills, particularly in helping dissatisfied, distressed or injured patients, is urgently needed. Consideration s...

Patient safety, law policy and practice

© 2011 editorial matter and selection: John Tingle and Pippa Bark. Patient safety is an issue which in recent years has grown to prominence in a number of countries’ political and health service agendas. The World Health Organization has launched the World Alliance for Patient Safety. Millions of patients, according to the Alliance, endure prolonged ill-health, disability and death caused by unreliable practices, services,and poor health care environments. At any given time 1.4 million people worldwide are suffering from an infection acquired in a health facility.Patient Safety, Law Policy and Practice explores the impact of legal systems on patient safety initiatives. It asks whether legal systems are being used in appropriate ways to support state and local managerial systems in developing patient safety procedures, and what alternative approaches can and should be utilized.The chapters in this collection explore the patient safety managerial structures that exist in countries where there is a developed patient safety infrastructure and culture. The legal structures of these countries are explored and related to major in-country patient safety issues such as consent to treatment protocols and guidelines, complaint handling, adverse incident reporting systems, and civil litigation systems, in order to draw comparisons and conclusions on patient safety.

Effective handling of complaints concerning children

Dealing with a complaint or lawsuit is an inevitable part of a medical career. It has been estimated that approximately 1% of all hospital admissions will result in care that could be regarded as negligent and that about 4% of patients are inadvertently harmed in some way by their care? A small proportion of these will result in complaints. Up until recently, there has been little training in effective complaints handling or in methods of minimizing the risk of the doctor-patient relationship breaking down. Support for medical staff has largely come from the defence organizations, with little help available internally from hospitals. In a North Thames study asking consultants and senior registrars 2 for their views on litigation and adverse events, it was found that overall approximately half of those in the surgical specialties had been sued at some point in their career, and a quarter in the medical. Out of 55 paediatricians, 40% had been sued. Clinicians reported feeling angry and distressed over the threat or actuality of being sued, and almost 15% had considered giving up medicine because of it. There has been much talk recently of considering complaints as an impetus for improvement and as an opportunity for patients to have a voice. As yet much of this is still rhetoric. Both the complainant, and the person involved in the situation being complained about often find the attitudes they meet unconstructive and demoralizing. It is not uncommon for both complainant and respondent to end up wondering why the complainant bothered complaining in the first place. In addition, the task has become increasingly

Psychiatrists' views of litigation and risk management

SPECIALITIES AT HIGH RISK for litigation, such as obstetrics and anaesthesia, are natural starting-points for risk management initiatives. Comprehensive risk management strateges have been established in a number of British obstetric units’ and it seems probable that surgical specialties will follow suit. Psychiatry has a lower incidence of litigation than the acute specialities, but in the USA there has been a substantial increase in both frequency of litigation against psychiatrists (from 1.5% per annum in 1969 to 5% in 1989) and in the costs of settlements and malpractice premiums. Most of these psychiatric claims involved suicide, attempted suicide or violence to others and risk management strategies to prevent such incidents are comparatively well de~e loped .~ Britain, although somewhat lagging behind the USA, may also be experiencing an increase in psychiatric litigation. The potential for litigation has probably been increased by the inadequate resourcing of the shift to psychiatric care in the community and the recent, tragic and much publicised attacks by psychiatric patients. The Ritchie inquiry into the care of Christopher Clunis, a young man with schizophrenia who killed a stranger in the street, found that his care was a ‘catalogue of failure and missed ~pportunity’.~ Lipsedge (1 995) has summarised the inquiry’s findings as follows: 2