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Case ref:201507751
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Date:September 2016
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Body:A Medical Practice in the Lothian NHS Board area
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Sector:Health
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Outcome:Not upheld, recommendations
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Subject:clinical treatment / diagnosis
Summary
Mr C attended two consultations with the nurse at the medical practice. Mr C said that at the first consultation he was not prescribed antibiotics. At the second consultation, Mr C said he had taken antibiotics prescribed for his wife. The nurse prescribed antibiotics so that Mr C could complete the course. There was an error in the number of antibiotics prescribed and Mr C was required to be issued with another three-day course. Mr C complained to us about the treatment he received. He said that the nurse had been dismissive of his symptoms.
We obtained independent advice from a nursing adviser and a GP adviser. They noted that the actions of the practice nurse at the first consultation had been reasonable and that Mr C did not require antibiotics at that time. It appeared that the second consultation had been difficult for both Mr C and the practice nurse. We were advised that it had been reasonable for the practice nurse to have told Mr C that he should not have taken his wife's antibiotics. The prescribing error had been accepted by the practice and no harm had been caused to Mr C. We did not uphold Mr C's complaint.
Several months later, Mr C attended an appointment with a GP. Mr C complained to us about his treatment and the attitude of the GP. The GP adviser found that the treatment received by Mr C was appropriate. We therefore did not uphold this complaint. It was clear the consultation had been challenging and unsatisfactory for both Mr C and the GP, who recorded personal comments about Mr C in the clinical records. We were advised that it was at times helpful for the management of future consultations for a doctor to record an objective description of a challenging consultation. However, during our investigation we found that the comments about Mr C were subjective and unnecessarily personalised and so could have a negative effect on the doctor/patient relationship. We therefore made a recommendation to address this.
Recommendations
We recommended that the practice:
- reflect on the comments of the GP adviser in relation to the implications for the patient directly, and for the doctor/patient relationship, of recording subjective and/or personalised comments about the patient.