AUTUMN 2014 SUMMONS AN PUBLICATION FOR MEMBERS • Saying sorry • GDC responds • A most serious case indeed • ESSENT IAL MEDICAL TEXTBOOKS MDDUS members SAVE 20% on all medical books when you order online at www.crcpress.com, enter discount code LBM25 at the checkout. FREE standard shipping worldwide. Expires 31/12/2014 Don’t forget to connect with us on social media to be the first to hear about author news, discounts and offers Like us on Facebook www.facebook.com/CRCPressMedical Follow us on Twitter @CRC_medical For more info, sample pages and to view the entire collection, visit: http://bit.ly/CRCMedical MDDUS .indd 1 12/06/2014 11:38:41 CONTENTS ESSENT IAL IN THIS ISSUE WHY do doctors fi nd it diffi cult to say sorry? It’s a key question in this on top of a recent Professional Standards Authority review in a post-Francis NHS with calls for a statutory duty of candour on which the GDC failed to meet seven out of 10 good regulation MEDICAL TEXTBOOKS top of professional obligations to be open and honest in standards in fi tness to practise. On page 10, chief executive and admitting errors. registrar Evlynne Gilvarry addresses some of the criticisms. Psychiatrist Aaron Lazare – author of the book On Apology MDDUS case fi les contain numerous examples of negligence MDDUS members SAVE 20% on all medical books when you – wrote: “We tend to view apologies as a sign of a weak character. claims resulting from failed joint and soft tissue injections – not But in fact they require great strength. Despite its importance just in technique but in poor consenting and explanation of risk. On order online at www.crcpress.com, enter discount code LBM25 apologising is antithetical to the ever-persuasive values of winning, page 16, Dr Lucy Douglas highlights new guidelines on best success and perfection. The successful apology requires empathy practice from the Primary Care Rheumatology Society. at the checkout. FREE standard shipping worldwide. and the security and strength to admit fault, failure and weakness. We also have Steve Ashton from Law at Work (p. 18) discussing Expires 31/12/2014 But we are so busy winning that we can’t concede our dental practice health and safety. Do you have risks hiding in plain own mistakes.” site? And on page 14 Allan Gaw recounts a medico-legal case On page 12 of this issue Dr John Dudgeon – a medical adviser at dating back to the founding of MDDUS and involving the the Scottish Public Services Ombudsman – explores the need for a domiciliary use of chloroform. Would the outcome have been culture change in attitudes to acknowledging mistakes. diff erent if ruled on by a judge today? Quite possibly not. The GDC has being facing increasing levels of fl ack over proposals to raise the annual retention fee by 64 per cent – and Jim Killgore, editor SAYING SORRY 12 John Dudgeon – GP and medical REGULARS adviser with the SPSO – calls for a 4 Notice Board culture change in attitude among 6 News Digest doctors towards saying sorry 8 Risk: What are my chances, doc? 9 Ethics: An ethical ecology A MOST SERIOUS CASE 10 Q&A: Evlynne Gilvarry, GDC chief 14 14INDEED executive and registrar What began with a simple work- 20 Case studies: Lunchtime fracas, related injury in 1902 would end a Capacity to consent, Post-op year later with a death, a court case complication and a piece of medico-legal history. 22 Addenda: Fatal self-confi dence, Allan Gaw investigates Scarifi cator, Crossword and Vignette: Charles Hawkins Craig CLINICAL RISK REDUCTION Macmillan, medical publisher 16 Lucy Douglas highlights new guidelines on best practice in joint and soft tissue injections HIDING IN PLAIN SIGHT 18 Health and safety expert Steve Ashton considers some risk areas in dental practice so obvious they 16 become invisible Cover image: Editor: Please address Design and production: Highland Landscape Jim Killgore correspondence to: CMYK Design by Denis Peploe Associate editor: 0131 556 2220 Son of Samuel Joanne Curran Summons Editor www.cmyk-design.co.uk John Peploe, the MDDUS noted Scottish Editorial departments: Mackintosh House Colourist, Denis MEDICAL Dr Jim Rodger 120 Blythswood Street Peploe inherited a DENTAL Mr Aubrey Craig Glasgow G2 4EA particular feeling for LEGAL Simon Dinnick Printing and distribution: the landscapes of the Highlands. This RISK Peter Johnson [email protected] L&S Litho painting depicts a landscape in the Scottish Highlands: Don’t forget to connect with us on social media to be the first to hear the sombre colour palette adds a melancholy mood to Summons is published quarterly by The Medical and Dental Defence Union about author news, discounts and offers the vast space depicted and is reminiscent of the style of Scotland, registered in Scotland No 5093 at Mackintosh House, demonstrated in the artist’s other Highland pieces. 120 Blythswood Street, Glasgow G2 4EA. • Tel: 0845 270 2034 • Fax: 0141 228 1208 Like us on Facebook www.facebook.com/CRCPressMedical Art in Healthcare (formerly Paintings in Hospitals Email: General: [email protected] • Membership services: [email protected] • Follow us on Twitter @CRC_medical Scotland) works with hospitals and healthcare Marketing: [email protected] • Website: www.mddus.com communities across Scotland to encourage patients, The MDDUS is not an insurance company. All the benefi ts of membership of MDDUS are discretionary visitors and staff to enjoy and engage with the visual as set out in the Memorandum and Articles of Association. arts. For more information visit www.artinhealthcare. The opinions, beliefs and viewpoints expressed by the various authors in Summons are those of the authors alone org.uk Scottish Charity No SC 036222. and do not necessarily refl ect the opinions or policies of The Medical and Dental Defence Union of Scotland. For more info, sample pages and to view the entire collection, visit: http://bit.ly/CRCMedical AUTUMN 2014 3 MDDUS .indd 1 12/06/2014 11:38:41 NOTICE BOARD MDDUS wins eco award The success follows 18 months of hard led by our staff Carbon Group over the past MDDUS has been awarded the work by members of the MDDUS Carbon year and a half. prestigious Carbon Trust Standard for its Group which was set up in January 2013 “This reflects the Union’s commitment to success in reducing carbon emissions. with the goal of implementing more sustainable, responsible business practices A campaign spearheaded by the Union’s environmentally friendly business practices both now and in the future. staff Carbon Group achieved a reduction of in its Glasgow offices. “We hope this award will be valued by 3.2 per cent in carbon emissions at its Over this period, the company and the both our staff and our members and will be Glasgow headquarters between 2012 and Carbon Group have introduced a number of taken as a sign that we take our corporate 2013. Overall gas usage fell by 12 per cent new measures including the installation of social responsibilities seriously.” while energy costs were slashed by a energy efficient lighting, a heating system Darran Messem, Managing Director, quarter. MDDUS staff vehicles for the upgrade, improved insulation of windows, a Certification at the Carbon Trust added: “It Glasgow office also recorded a drop in fuel move to petrol company vehicles and a staff is genuinely impressive to see such a well consumption of almost four per cent. awareness campaign. It’s hoped the scheme mobilised internal team, focused on creating The Standard is a mark of excellence will be extended to MDDUS offices in and delivering reduction strategies to awarded by the Carbon Trust in recognition London in the near future. achieve the Standard. We congratulate the of a company’s efforts to reduce its carbon MDDUS Chief Executive Professor Gordon team at MDDUS for all their hard work, footprint. It is valid for two years and firms Dickson said: “I am very proud that MDDUS which serves to show other organisations who want to retain it must continue to cut has been awarded the Carbon Trust what can be achieved through a focused emissions year-on-year. Standard following a committed campaign approach.” Caution advised over waiting list initiatives contract. However, it is not true to say that NHS-type indemnity THE NHS has been under increasing pressure to maintain “follows the patient”. Doctors must not simply assume that if and reduce the length of time patients wait for procedures. To these are patients undergoing procedures as NHS patients that this end many hospitals have out-sourced procedures to private they are automatically covered by NHS indemnity. hospitals. Others have used their own NHS staff to undertake Members who wish to undertake this kind of extra work must extra sessions within their own and other hospitals. be clear or have it made clear to them whether the procedures Patients within the NHS are protected by NHS indemnity under are covered by one of the NHS indemnity schemes. various schemes.In England, trusts contribute to the Clinical If the work is not so covered, members will have to check if Negligence Scheme for Trusts (CNST) and are thus covered by their current subscription is adequate and appropriate to allow NHS indemnity. Some other private institutions may also join the them to undertake this extra work. CNST scheme and so become indemnified through the same Members must ensure that they fully understand the terms on scheme.There are similar schemes in Scotland (CNORIS) and which they take on such work and, more importantly, carefully Wales (WRP), and Northern Ireland has a risk-pooling scheme. check the terms of the agreements or contracts for professional Doctors may be invited to undertake these waiting list indemnity requirements.