WINTER 2016 SUMMONS AN PUBLICATION FOR MEMBERS • Medicine on the edge • Sepsis alert • Unfit to drive • CONTENTS THE problem of protocols are key to reducing the cognitive overload that comes increasing demand at a with high-stress emergency situations. time of constrained Medical innovation and scientific advances are discussed in a FROM THE EDITOR resources will be familiar different context by Deborah Bowman on page 9, highlighting to everyone working within the NHS. New approaches aimed at the ethical importance of interpretation by clinicians when tackling this are welcome, and in this issue, Professor Jason applying new discoveries to patient care. On page 8, Alan Frame Leitch, the Scottish Government’s national clinical director, discusses health literacy and its importance in shared decision discusses his role in planning greater integration between health making and informed consent. and social care, and more patient-centred care (p. 10). Douglas Hamilton discusses the challenges faced by dentists Sepsis is a relatively common, life-threatening condition in adhering to good practice when prescribing antibiotics (p. 18). affecting 150,000 people per year in the UK, resulting in Doctors accustomed to acting as patient advocates may find 44,000 deaths. On page 16, Dr Ron Daniels, chief executive of themselves in the uncomfortable position of having to act the UK Sepsis Trust, highlights recent NICE guidelines aimed at against a patient’s wishes and breach confidentiality if someone reducing misdiagnosis and delays in treatment. deemed medically unfit refuses to stop driving. GMC guidance On page 14, Jim Killgore talks to consultant Dr Stephen on reporting concerns to the DVLA is reviewed on page 12. Hearns about his innovative and at times dramatic work with the Scottish Emergency Medical Retrieval Service (EMRS). Rigid Dr Barry Parker AN INTEGRATED APPROACH RESISTANCE IS FUTILE 10 New MDDUS Board member 18 Doug Hamilton considers Professor Jason Leitch talks to the dilemma faced by dentists in Summons about ongoing reform in prescribing antibiotic treatment Scottish public health and his role UNFIT TO DRIVE REGULARS 12 Barry Parker looks at the 4 Notice Board factors to consider when a medical 6 News Digest condition may compromise a 8 Risk: Health literacy 14 patient’s fitness to drive on the information superhighway MEDICINE ON THE EDGE 9 Ethics: Ethics as interpretation 14 Stephen Hearns discusses 20 Case studies: Pressure to cognitive overload and other prescribe, No prophylactic antibiotics, challenges with the Scottish EMRS Abdominal lump 22 Addenda: Object obscura: Goa CLINICAL RISK REDUCTION: stone, Book choice: Being Mortal: 16 SEPSIS ALERT Illness, Medicine and What Matters Dr Ron Daniels of the UK Sepsis in the End, Crossword and Vignette Trust highlights the importance of – Frank Pantridge, cardiologist and improved diagnosis and management inventor of the portable defibrillator 10 in this oft-missed condition Cover image: Winter Editor: Please address Design and production: Tree, Mary Paton. Dr Barry Parker correspondence to: Connect Communications Oil on board, 1970. Managing editor: 0131 561 0020 Born in Ayrshire in Jim Killgore Summons Editor www.connectmedia.cc 1920, Paton studied at Edinburgh College of Associate editor: MDDUS Art under McTaggart Joanne Curran Mackintosh House and Gillies. She spent Editorial departments: 120 Blythswood Street most of her later life MEDICAL Dr Richard Brittain Glasgow G2 4EA in Aberdeenshire, and DENTAL Mr Aubrey Craig Printing and distribution: was inspired by the LEGAL Simon Dinnick [email protected] L&S Litho surrounding landscape. She died in 1990. Summons is published quarterly by The Medical and Dental Defence Union of Scotland, registered in Scotland No 5093 at Mackintosh House, Art in Healthcare (formerly Paintings in Hospitals 120 Blythswood Street, Glasgow G2 4EA. • Tel: 0333 043 4444 • Fax: 0141 228 1208 Scotland) works with hospitals and healthcare Email: General: [email protected] • Membership services: [email protected] • communities across Scotland to encourage patients, Marketing: [email protected] • Website: www.mddus.com visitors and staff to enjoy and engage with the visual The MDDUS is not an insurance company. All the benefits of membership of MDDUS are discretionary arts. For more information visit as set out in the Articles of Association. www.artinhealthcare.org.uk Scottish Charity No SC 036222. The opinions, beliefs and viewpoints expressed by the various authors in Summons are those of the authors alone and do not necessarily reflect the opinions or policies of The Medical and Dental Defence Union of Scotland. WINTER 2016 3 NOTICE BOARD Survey highlights quality A RECENT survey of MDDUS NHS England Winter Indemnity Scheme members contacting our advisory service NHS England has launched a scheme to meet the found that a majority highly rated the costs of indemnifying any additional out-of-hours (OOH) experience – with 80 per cent scoring it a work undertaken by GPs this winter. 5 or above on a scale of 1 to 6 from The scheme has been developed in conjunction with UK ‘disappointing’ to ‘excellent’. Members medical defence organisations, including MDDUS, and contacting the team in regard to a claim runs between 1 October 2016 and 31 March 2017. It is or complaint were even more positive designed to meet the costs of indemnifying additional about the experience, with 94 per cent OOH work this winter and does not apply to pre-existing rating it a 5 or above. indemnity arrangements. Nearly 200 members responded to the GP members interested in accessing the scheme should survey which also asked how satisfied initially make contact with their local OOH provider to members were with the assistance check on likely availability of additional vacant shifts. The provided by MDDUS rated on a scale of 1 OOH provider will then be able to advise whether pre- (disappointed) to 6 (delighted) over four existing corporate indemnity would cover such work or if categories: timely manner, informative, additional personal indemnity would be required through professional and empathetic. The average the NHS England Winter Indemnity Scheme via MDDUS. rating in all these categories was 5 or GP members should agree with an OOH provider the above. likely number of sessions to be worked over the period of The survey also found that 99 per cent the scheme (up until 31/3/17). GPs will then be able to add of members who had been assisted with a these additional sessions to their current membership with claim/complaint said they would payment being made directly to MDDUS by NHS England. recommend MDDUS to a colleague. Go to www.mddus.com/forms/winter for an Another separate survey found that application to add additional OOH sessions funded by among 1,849 respondents using our online the scheme. application form, the top factor attracting them to MDDUS membership was our competitive subscription rates (60 per members rely on us to deliver our services partners who are members of MDDUS can cent) followed by recommendations from with the utmost professionalism. They rely look to us for assistance, including colleagues (51 per cent). on us to be responsive – quick, flexible and indemnity for claims that might be These encouraging results correspond to empathetic. They rely on us to provide brought by a patient. Any indemnity is a continued strong growth in our good value. We have done all three and given through the vicarious liability of membership, with an 11 per cent increase will continue to do so. I believe these MDDUS GP partners and as such, any in total active membership in 2015 as results demonstrate just how much we payments made by MDDUS will be reported in the latest MDDUS Annual have achieved.” proportionate to a head count of MDDUS Report and Accounts, published in members amongst the partners. September of this year. Indemnity for healthcare It should be noted that MDDUS would MDDUS CEO Chris Kenny said: “Our students not indemnify individual students per se. It is possible that the student could be sued MDDUS recognises that GP practices in his or her own right and may need to provide a rich learning environment for a consider obtaining personal indemnity for wide range of student healthcare complete peace of mind. Similarly, the professionals, including medical students, university or employing Trust is likely to student nurses and physician associate retain a degree of vicarious liability for the students. student nurse and MDDUS reserves the Where a student on placement within a right to pursue any third party for a practice is acting in accordance with contribution if we consider this to be duties delegated to him or her, the GP appropriate. partners may be held vicariously liable for Chris Godeseth, head of underwriting, negligent harm caused to patients. GP MDDUS ● NEW MDDUS TELEPHONE are not linked to a specific should not be charged extra for our FREE prize draw to win £50 NUMBERS New contact numbers geographical area but are charged calling our ‘0333’ numbers. of iTunes vouchers. Keep an eye make it easier for members to at the same rate as normal local ● STUDENT FACEBOOK on our Facebook page for details, get in touch. Contact our main or national landline numbers COMPETITION Calling all as well as all the latest news for switchboard on 0333 043 4444 (beginning ‘01’ or ’02’). Mobile medical and dental students – ‘like’ medical and dental students. and our membership team on users whose phone tariff includes our MDDUS Student Facebook Find our page at www.facebook. 0333 043 0000. The new numbers free landline calls/inclusive minutes page and you will be entered into com/mddus.student or search 4 SUMMONS NOTICE BOARD Keep us informed New appointments to MDDUS Board SUBSCRIPTION rates for doctors in MDDUS confirmed two key appointments to the Board at the AGM in private practice are based partly on work September.