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Marriage breaks your heart!

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I met Evelyn, a 43-year-old obstetric patient, when I was a medical student. Two of us were asked to conduct a full history and examination with the perennial student attraction being ‘an interesting patient with a hole in the heart’. She was great and talked about the straightforward birth of her seventh child and how well her heart continued to cope. Of course we examined her cardiovascular system and assessed her condition as an atrial septal defect. When asked about how her husband felt about having yet another child she replied that she wasn’t married but that Terry was the father of all her children. She could sense that we looked bemused and added ‘when I was very young my doctor said that with your heart you should not get married—and I have followed his advice to this day’.

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DISCUSSION AND LESSONS LEARNED

  • This extraordinary story highlights the importance of being careful of what you say and how you say it in giving advice to patients. The days of the authoritarian, all-powerful doctor have long gone although I guess we have all had experiences of present day patients hanging onto our words and advice. It adds further support to the importance of providing patient education handouts to supplement the spoken word.

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Communicating the bad news of HIV infection

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Once again, reviewing litigation cases of colleagues is a learning experience.

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A most unfortunate incident was that of a well known first-class suburban GP who was consulted by a 37-year-old man for a possible sex-related problem. She organised screening tests and the HIV test returned an equivocal result with the comment ‘most likely positive but a follow up test is advisable’. When the patient returned he was counselled by the GP who organised a repeat test and suggested that he return to discuss the results. He had a busy forthcoming schedule and could not pinpoint a suitable time so it was decided that the clinic would contact him when the result was available. The follow up test was positive so Dr N decided to ring the patient and arrange an appointment. However, due to the pressure of curiosity by the patient she reluctantly told him the bad news over the phone. The patient came in for counselling but was very distressed. Eventually he sued for breaking the news over the phone claiming that he could not cope with returning to the place in which he received the news of his positive test. The case was also bad news for medical defence.

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Readers may recall the huge pay out against two Sydney GPs when the female partner of a HIV positive patient became infected. Lawyers for the plaintiff argued that it was the GP’s responsibility to ensure that the patient’s partner was informed.

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DISCUSSION AND LESSONS LEARNED

  • These outcomes seem unjust ...

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