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Clinical decisions under pressure

Dr Andrew Broad, MBChB, Senior Medical Adviser, Avant

Wednesday, 24 November 2021

Woman in distress with crying baby

It’s sometimes difficult to keep a clear head when facing urgent medical situations and pressure from family members. These situations can lead you to ignore your gut instincts and cloud clinical decisions, but how you manage them can make all the difference.

Glue in child’s eye

A GP registrar found himself in a pressured situation when a mother made a last-minute appointment for treatment of a laceration near her toddler’s eyebrow. The child was a new patient and the doctor’s last appointment at the end of a long day*.

The child’s mother was understandably frantic and urged the doctor to use glue to seal the wound. In hindsight, the trainee said he would have used Steri-Strips™, but at the time he yielded to the mother’s demands.

He applied GluStitch® to the cut in small drops and spread it over the wound. Unfortunately, a small amount trickled onto the child’s eyelid and dried. As a result, the eyelid on the medial side became stuck together and would not fully open.

The mother panicked and the doctor immediately flushed out the child’s eye with water and sent him to the Emergency Department (ED). When the ED doctor examined his eye, it was approximately 60% open. Fortunately, a few days later, he was able to fully open his eye and there was no corneal damage.

Following the incident, the doctor called the child’s mother to check there were no ongoing problems, and the child made a full recovery.

Legal action avoided

The doctor contacted Avant to notify the incident and seek advice. He was provided peer support by one of our medical advisers who reassured him that problems with liquid adhesives can occur. The trainee was reminded to take stock if necessary, during urgent situations, and to resist pressure from patients or family members to treat if their opinion differs.

He was advised to document the incident in the child’s medical record and that the child was sent to the ED. The medical adviser also encouraged him to say sorry to the child’s mother for any harm and stress caused, in line with the open disclosure process.

The doctor empathised with the stress and worry the child’s mother had gone through, and said he was sorry the incident had occurred. Ultimately, she was satisfied with the course of action taken and her child’s recovery.

Demonstrating empathy

In cases like this, an apology can help diffuse the situation because it acknowledges what the patient or their family has suffered and validates their experience. It can also often minimise the chance of a complaint or legal action being brought against a doctor. An apology is not about blame or liability, but about expressing empathy with the patient or their family for the events that occurred. Saying, “I’m sorry you had this experience,” in a genuine manner is often appropriate.

Key Lessons

  • Take stock before making any important clinical decisions. Being pressured by a patient into providing treatment you believe is inappropriate, is generally not accepted as a defence if a complaint or claim is made.
  • Document any adverse event in the patient’s medical records and any further treatment.
  • Follow the open disclosure process. Where appropriate, say you are sorry for what has happened. This acknowledges the harm the patient or family has experienced and can preserve the doctor-patient relationship and prevent the incident from escalating into a complaint or claim.

Useful resources

*This is a scenario based on a compilation of member calls to our Medico-legal Advisory Service.

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