Unpacking the decision-making process

The complaint 

The complaint alleged that the practitioner didn’t provide the results of a CT scan in a timely manner.

Assessment 

The Medical Council decided there had been no departure from acceptable standards to warrant further action. It would be unreasonable to expect results on the same day or following day from when the tests were conducted, except in urgent circumstances. Diagnostic processes often require time for analysis and a delay does not necessarily reflect failure in the provider’s care

Outcome at consult 

Discontinued the complaint

The complaint

The complaint alleged the practitioner failed to adequately diagnose the cause of hip pain and adequately treat it, with complications resulting in the patient requiring a hip replacement.

Assessment 

In their response to the complaint, the practitioner was very reflective. However, they did not demonstrate sufficient knowledge of the risks of steroid injections (including avascular necrosis),and were not pre-empting with arranging bone densitometry. Advice was considered necessary to ensure the practitioner amended their practice.

The doctor reflected on their practice, which is highly encouraged in these circumstances.

The  doctor's self-reflection helped the Council to decide to discontinue the complaint with comments. This is because the doctor could show how they could improve their practice and demonstrated a willingness to change.

Outcome at consult

Discontinued with comments. The practitioner received a letter acknowledging their reflective response and steps taken to ensure their practice aligns with Good Medical Practice: A code of conduct for doctors in Australia.open_in_new Comments were made advising the practitioner to ensure they are aware of the risks of any proposed procedures or treatments,and have a low threshold for referring a patient when there are knowledge gaps or opportunities for preventative care.

The complaint. 

The complaint was made by another practitioner who alleged that the practitioner inappropriately prescribed opioids to a patient. The complaint explained that the patient had a weaning plan in place for their opioids but that the doctor prescribed higher doses than had been previously agreed to and that the patient was drug dependent and known to seek prescriptions from multiple doctors

Assessment 

Clinical assessment of the complaint was critical of the practitioner prescribing to a drug-dependent patient and the lack of specialist involvement despite high dose opioid use. Medical records were also conspired inadequate. In their response to the complaint, the practitioner was not reflective on the issues identified in this complaint.

Outcome at consult

Referred to Council

Action taken by 

Council The practitioner was asked to complete self-reflection exercise focusing on the performance issues identified in the complaint (i.e. patient assessment, clinical decision, patient management, prescribing of S4D/D8 medications, and medical records).

Review of self-reflection 

The practitioner was extremely reflective of their shortcomings and had made significant changes to their practice to mitigate the future risk of a similar incident occurring. This included an education plan developed together with their medical indemnity insurer.

Final outcome 

The Council considered the practitioner’s reflection positively and resolved that the matter be concluded by writing a letter of advice including recommendation to continue to implement the changes suggested in their response.

The complaint 

The complaint alleged poor visual acuity following cataract removal. The complaint explained that the practitioner was dismissive of their concerns but later found out the intraocular lens was inserted incorrectly. The complaint also noted that they were not aware that this was a potential complication. The practitioner had a history of multiple complaints relating to procedural complications.

Assessment 

Clinical assessment of the complaint was critical of the doctors’ records, with no documentation relating to risks/complications associated with procedures and no evidence of informed consent. They were also critical of the doctors’ management of complications and lack of documented review on follow-up.

Outcome at consult 

Referred to Council.

Action taken by Council 

The practitioner was asked to complete a self-reflection exercise focusing on the performance issues identified in the complaint (i.e. patient assessment, patient management and medical records). The Council did not consider that the practitioner was reflective and had not made changes to their practice after this complaint. The practitioner was therefore referred to a performance assessment to be completed in their practice.

Outcome at performance assessment (practice based) 

The practitioner underwent a comprehensive assessment of their practice including a general interview, observation of consultations and procedures, a medical record review, and clinical practice scenarios).

The assessors concluded that the practitioner’s performance was unsatisfactory in the domain of patient management (noting no documented evidence of informed consent, other than a generic consent form which often did not detail the procedure being completed on any risks associated) and medical records (noting inadequate documentation of patient consultations, and limited information to corroborate the doctor’s version of events).

Final outcome 

The practitioner was provided with advice about how they can improve their practice. In order to ensure that the practitioner made the required changes to their practice and improve their performance, conditions were imposed on the practitioner’s registration requiring them to undergo a repeat medical record audit in 6 to 12 months.