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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

You are expected to discuss a clinical problem with the facilitator role playing your senior colleague.

Scenario

Last Friday you did your first evening on call for the practice. It was much busier than you had expected. As it was your wedding anniversary you were keen to get home as soon as possible.

You are a bit puzzled as to why the practice principal has asked to chat with you after this morning’s surgery about a problem. Your memory is that you saw mostly kids with runny noses and one with an ear infection.

INSTRUCTIONS FOR THE PRACTICE PRINCIPAL

Last weekend you were on call when you received a phone call from an angry and anxious mother, Debra Poole. Her son Declan, aged four, had a painful ear and they had come to see the new doctor at the practice. Debra said that the doctor seemed to be in a hurry and had a quick look in his ears but no further examination before prescribing amoxycillin.

Debra gave Declan the first dose of the medication but then looked more carefully at the packet and saw the drug was similar to penicillin. Two years previously Declan had had an allergic reaction to penicillin requiring him to stay overnight in hospital. Once she realised what had happened she went straight to the emergency department. As a precaution he was admitted to hospital for observation. Fortunately, Declan did not react to the single dose of amoxycillin but Debra lost a day’s pay because she monitored him the following day.

When you talked with Debra on the weekend you promised that you would discuss this with your colleague on Monday.

SUGGESTED APPROACH TO THE CASE

Doctor to listen carefully to the practice principal’s concerns

Doctor demonstrates understanding of different issues involved

  • — Problem of a cursory clinical examination and risk of missing other more serious pathology

  • — Impact of hurrying the consultation

  • — Inappropriate prescribing of amoxycillin despite allergy—an avoidable and potentially fatal mistake

  • — Financial impact of mistake on patient’s family

  • — Impact of the error on the practice reputation/business

Doctor acknowledges mistakes and outlines plans for action

  • — Apologise to the family for the mistake

  • — Apologise to the practice principal for impact on practice/reputation

  • — Conduct more appropriate full physical examinations in the future

  • — Check with patients about allergies and use information in the records

  • — Check if Declan’s file includes his penicillin allergy and update it if required

  • — Undertaking prescribing modules from RACGP or NPS MedicineWise

  • — Seek assistance with consultation techniques such as asking senior doctor to sit in or observe videotaped consultations

  • — Ask practice principal if there is anything else that ...

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