Chapter 23: Professionalism pitfalls

TWENTY YEARS OF WORK AS A MEDICO-LEGAL ADVISER HAS TAUGHT ME THE FOLLOWING LESSONS:

1. Good medical practice is your best defence—practice as a doctor, not a lawyer (or as a lawyer thinks you should practice).

2. Knowing when (and how) to say ‘no’ is one of the most important skills to reduce your medico-legal risk.

3. Every doctor makes mistakes. It is how you deal with these that shows your professionalism. The only real mistake is the one from which we learn nothing.

4. The worst thing you can do when dealing with complaints, claims and disciplinary matters is to be dishonest.

5. You can (and should) always obtain advice and support when dealing with an adverse event or medico-legal issue.

6. Your health and wellbeing is vital to ensure your patients’ wellbeing and safety.

DRIVING DILEMMAS CAN DRIVE YOU UP THE WALL

As illustrated by the following cases, managing a situation where a patient’s medical condition means they are no longer fit to drive is not easy, especially when it impacts on a patient’s independence or income.

Miss Daisy

Daisy was a fiercely independent, retired lecturer in her 80s. Her mobility had decreased over the years due to chronic back pain and osteoarthritis. Three of her friends had attended the local police station to raise concerns about her fitness to drive. She had been observed to have slow reaction times, would fall asleep easily and did not appear to be in control of her car. Daisy had been informed by all of her treating doctors that she was no longer fit to drive. Her driver’s licence was cancelled.

Daisy shopped around to a number of doctors to try to get her licence reinstated. Eventually she persuaded a new GP that she was fit to drive by informing him that she was no longer on opiates and her balance was so good that she was attending twice-weekly dance lessons. The GP issued an unconditional licence, to be reviewed annually. Two weeks later Daisy died in a single car accident.

Bruce

A heavy drinker, smoker and eater, Bruce worked as a long-haul truck driver. He had poorly controlled type 2 diabetes and probable sleep apnoea. Bruce saw his GP for the renewal of his commercial driver’s licence. The GP informed Bruce that she was not prepared to renew his licence until his sleep apnoea had been investigated and his diabetes was under better control.

A few months later, Bruce was using his CPAP machine each night, regularly testing his sugars and had his HbA1c under 8 for the first time in years. He told his GP that he’d never felt better!

Rhea

Rhea had just obtained her driver’s licence and her first job when she suffered her first epileptic fit. ...