Case Study: When should I take extra care?

Obviously some situations are more prone to lead to medico-legal problems than others. High risk situations have been identified for adverse events involving JMOs, some are shown below. This list is not exhaustive, but you are especially vulnerable in clinical situations that are brief or unfamiliar.

In these situations, you should pay particular attention to history taking, review of the medical records, careful communications with the patient and accurate clinical documentation.

Here are some key 'Tips for avoiding Medico-legal Problems'

• If you are uncomfortable about making a clinical decision or performing a particular procedure - no matter how small - discuss it with your registrar or consultant.
• If you are uncertain about an issue then ask your registrar, consultant or other senior practitioner about it at an appropriate time.
• Make good, concise, contemporaneous notes. Remember that the purpose of the medical records is to allow another practitioner to continue the management of the patient's care.
• Be aware of the 'high risk' clinical situations for adverse events listed.
• Maintain your own medical indemnity cover.
• Remember that your interests and those of the hospital and other staff members may not always be the same. Independent representation of your interests is crucial and reassuring if faced with this situation.
• If you are involved in an adverse event related to a patient under your care, contact your MDO for advice. This will ensure that you follow correct procedure and produce an appropriate account of the event. It will also allow you to work through the distress you may be feeling about the event.

High Risk Situations for Adverse Events involving JMOs

• Clinical situations that are brief or unfamiliar
• Overtime
• Patients transferred from ICU or operating theatre to ward
• Paediatric patients
• Administration of IV medications
• Emergency department
• Trauma
• Failure to diagnose significant head injuries, particularly in intoxicated patients
• Missed fractures
• Lacerations - missed nerve and tendon injuries
• Failure to diagnose medical conditions
• Acute myocardial infarction
• Meningitis
• Depression and suicidality
• Failure to diagnose acute surgical conditions
• Subarachnoid haemorrhage
• Appendicitis
• Ectopic pregnancy

These case histories are based on actual medical negligence claims, however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved.
This information is intended as a guide only and should not be taken as legal or clinical advice.
We recommend you always contact your indemnity provider when advice in relation to your liability for matters covered under your insurance policy is required.

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