Some of the most important and best lessons in a doctor’s career are learnt from mistakes. However, an awareness of the common causes of medical errors and developing positive behaviours can reduce the risk of mistakes and litigation.

Written for junior medical staff and consultants, and unlike any other clinical management title available, Avoiding Errors in Adult Medicine identifies and explains the most common errors likely to occur in an adult medicine setting - so that you won’t make them.

The first section in this brand new guide discusses the causes of errors in adult medicine. The second and largest section consists of case scenarios and includes expert and legal comment as well as clinical teaching points and strategies to help you engage in safer practice throughout your career. The final section discusses how to deal with complaints and the subsequent potential medico-legal consequences, helping to reduce your anxiety when dealing with the consequences of an error.

Invaluable during the Foundation Years, Specialty Training and for Consultants, Avoiding Errors in Adult Medicine is the perfect guide to help tackle the professional and emotional challenges of life as a physician.

Contributors, viii

Preface, ix

Abbreviations, x

Introduction, xi

Part 1

Section 1: Errors and their causes, 1

A few words about error, 1

Learning from system failures – the vincristine example, 1

Evidence from the NHSLA database, 8

The patient consultation, 10

Failure to identify a sick patient, 12

Inability to competently perform practical procedures, 13

Failure to check test results or act on abnormal findings, 14

Prescribing errors, 14

Sources of error in the case of vulnerable adults, 16

References and further reading, 18

Section 2: Medico-legal aspects, 19

Error in a legal context, 19

Negligence, 19

Clinical negligence, 20

Issues around consent, 23

An attorney refusing treatment, 27

A patient without capacity refusing treatment, 27

Emergency treatment, 28

Deprivation of liberty safeguards, 29

Part 2 Clinical

Section 1: Civil liability, negligence and compensation, 36

Case 1 A shaky excuse, 37

Case 2 Making matters worse, 40

Case 3 Chase the bloods, 43

Case 4 Falling asleep en-route, 45

Case 5 Bad luck or bad judgement, 48

Case 6 An opportunity missed, 51

Case 7 Better late than never, 53

Case 8 Man down, 56

Case 9 Cry wolf, 58

Case 10 Not a leg to stand on, 60

Section 2: Unexpected death: the coronial system and clinical risk management, 62

Case 11 A doubly bad outcome, 63

Case 12 Difficulty with diarrhoea, 66

Case 13 A flu-like illness, 69

Case 14 Falling standards, 72

Section 3: An approach to complaints, 74

Case 15 A woman with chest pain, 75

Case 16 Clumsiness, 78

Section 4: Competence, 80

Case 17 A change in plan, 81

Case 18 Starving to death, 85

Case 19 An irregular presentation, 88

Case 20 Irrational but not incompetent, 90

Section 5: Restraint, 92

Case 21 A challenging discharge, 93

Case 22 Ruling out the organic, 96

Case 23 Endless wandering, 99

Case 24 Can you please take these handcuffs off?, 101

Case 25 Own worst enemy, 103

Section 6: Miscellaneous, 105

Case 26 All eggs in one basket, 106

Case 27 A major mix-up, 108

Case 28 Under the radar, 110

Case 29 A cantankerous recluse, 113

Case 30 Keep an open mind, 115

Case 31 Healthcare acquired infection?, 117

Case 32 Backing the wrong horse, 120

Case 33 A surprising turn of events, 122

Case 34 Funny turn, 125

Part 3 Investigating and dealing with errors

1 Introduction, 127

2 How hospitals try to prevent adverse errors and their recurrence, 127

3 The role of hospital staff, 132

4 The role of external agencies, 134

5 Hospital investigations, 137

6 Legal advice – where to get it and who pays, 141

7 External investigation of errors and incidents, 143

8 The role of the doctor, 160

9 Presenting oral evidence, 162

10 Emotional repercussions, 164

11 Conclusion, 164

References, 164

Index, 167
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