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advice needed please!

Discussion in 'General Issues and Discussion Forum' started by Louisepodiatry, Sep 13, 2014.


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    Hi all. Im a podiatrist with 6 years nhs experience and 2 years private practice. I saw a patient yesterday. He has made a complaint this morning and wanted some advice on people who may have been in a similar situation.

    Pt is diabetic (at risk), on warfarin for irregular heart beat) and attended because he wanted nails cut. He explained his wife did them (as he is morb obese can't reach feet) and she usually dug the corner out as ingrowing. O/e one toe nail had o/p and slight sub hd, upon removal small spot of blood. Not bleeding but advice given dry dressing applied. He has subsequently complained overnight saying going to sue me for negligence. Practice manager is sending an email explaining how sorry we are etc and how not intended to cause pain etc. Has this ever happened to you? Im petrified! Typical it would happen on a fri/sat as society shut for advice!

    We have suggested out of hours if he is concerened. I obviously didn't intend to cut him but toe swollen due to o/p and using a blade sometimes it halpens. Is it really a case for negligence?
     
  2. Hi Louise,

    From what you write the answer is unequivocally no.

    Best wishes
    Mark
     
  3. LeonW

    LeonW Active Member

    Just for next time better to be a bit more conservative with more sensitive cases
    -diabetes
    -warfarin
    just be a bit more conservative, like not needing to get rid of ALL the HK. Sometimes it is better to leave a bit than risk cutting the pt.
     
  4. Thanks everyone I was actually a little conservative explained this and now he is sayibg ge wants a full refund or he is going to the press! Nasty character I think. Going to give refund (although don't feel I should) to get rid. Thank you for advice everyone.
     
  5. Shouls have said he wants refund as I didnt remove it all! Can't win. Some odd ones out there.
     
  6. W J Liggins

    W J Liggins Well-Known Member

    Hi Louise

    First, stop worrying (if possible). Even if he did sue, the case would be governed by the Bolam principle. In a nutshell, this states that negligence is determined by what the average practitioner might or might not be expected to carry out in a given circumstance. In your case, this means that the patient could not expect the highest level of treatment and not the lowest level, just the average. In other words, he has no chance. In any case, this is why you carry insurance, so let them do the worrying on your behalf - it's what you pay them for! The important thing is that you meticulously record details of your treatment, including pre-op and post-op skin cleansing etc. It would also be sensible to record all the correspondence and 'phone calls with the patient even though it may be after the event. If he speaks to you again, record, in writing, what was said immediately. This is described as 'contemporaneous' and has some force in law. If I may, I would suggest that you reconsider refunding the fee since that could be seen as an admission of fault. You gave him the best treatment that you could under the circumstances, and it is regrettable that there was a problem but this could have happened to anyone. There is no guarantee that he will not carry out his threats anyway, and if he does try to sue you (which will fail) at least your solicitor will be able to enforce a gagging clause which will prevent him 'badmouthing' you.

    All the best

    Bill Liggins
     
  7. That is great advice thank you bill.
     
  8. Lorcan

    Lorcan Active Member

    Louise
    Do not refund unless you think you did an inappropriate job. Otherwise you'll have to do the same with every such bogus claim. If you followed society guidelines and your records are as they should be you have no case to answer.
    I would urge to stand up to him politely of course. He will likely go away like all bullys do when stood up to and if not as long you have acted professionally you will have no case to answer.
     
  9. Lab Guy

    Lab Guy Well-Known Member

    Bill is right, there is no malpractice case so do not worry. Absolutely do not give a refund as it will not help but only hurt you as it can be perceived that you provided less than standard care.

    Do not give your power away to this patient and drain you. Your a professional, take your power back, reclaim your confidence and move forward. There is nothing to fear here. Believe that you always do your best with every patient encounter, and fear will not come through the door.

    Steven
     
  10. Great advice Thank you. Hoping I will sleep tonight now having discussed it all with you all.will let you know v what happens!
     
  11. LeonW

    LeonW Active Member

    It may make more sense to just give him a refund as that may be the most economical if you are sure he will proceed against u if you dont give him a refund. Even though he is wrong instead of standing by your "principles" it may be much cheaper to just give him a refund and be done with it. Only give a refund if you are sure he will go to press, courts etc if you dont give him a refund. Time spent with lawer, explaining your position to press..... Much more economical sense to just pay him out. Spend your time seeing patients not lawers. But if care more about "winning" or "being right" than just making money. By all means dont give in and give him a run for his money. But sometimes a man like this has nothing better to do than cause trouble and get into fights. Are you sure you want to be the one to satisfy his desire for conflict? I am sure you have better things to do.
     
  12. W J Liggins

    W J Liggins Well-Known Member

    It is, to say the least, unfortunate that a fellow professional advises paying off an individual who is seeking to vilify a colleague. Leave that sort of behaviour to the insurance companies. You have done nothing wrong.

    Bill Liggins
     
  13. Peter

    Peter Well-Known Member

    I would hope in the long run nobody accepts to treat this individual in the future. Would he sue his wife if she cut him trying to treat his high risk feet?
     
  14. akn102

    akn102 Active Member

    Sorry to hear about this Louise, this is everyone's worst nightmare dealing with these sort of people. As others have said it sounds like he's trying to bully you.

    I absolutely would not refund him BUT if you do do it in writing and put 'Without Liability' at the top of the letter. I remember from many many many years ago when I was secretary to a solicitor you write that and clearly state you are refunding but without liability - in other words your refund does not suggest you are in any way to blame but you are doing it has a gesture of goodwill (and to get rid of him - don't write that!).

    Try and stop worrying (impossible I know) he'll probably back down when he realises he can't bully you!
     
  15. simonfeet

    simonfeet Active Member

    In 30 years of practice, I've experienced this on 3 occasions. Its horrible, especially as you sound like a conscientious practitioner. Do not admit any liablity & I'm surprised your practice manager seems to have written a letter implying blame . Do speak to the Society as they will give you clear instructions about what to do.
    Make sure your notes are clear & comprehensive & if you did all you could at the time of the incident, dont worry. Some patients are so ready to apportion blame nowadays instead of just admitting that sh** happens.
    I know its difficult at the moment but just think of the people that express their gratitude for your treatment. Again my sympathy but you will get through this.
     
  16. terigreen

    terigreen Active Member

    Please don't worry. In our practice things happen. The key is to document, document and document. If anything like that did happen to us, the doctor himself would call the patient the evening of and the next day. He would also make himself available to see the patient outside of normal office hours. Statistics show that patients don't sue doctors in large numbers if they are treated kindly and professionally.

    Good Luck,

    Teri
    Atlas Biomechanics
     
  17. dsfeet

    dsfeet Active Member

    hi Louise
    completely agree with above ...........the importance is document , and document. Make sure you have included autoclave cycle number/ sticker are all surgery protocols are in place.
    and don't admit guilt, this was a unintended occurrence.

    speaking from experience, 1 case ..........patient of long standing diabetic/ neuropathy presented with blood blister on toe/apex. Treated and advised to return 2 days later to check healing.............didn't show.......documented.
    appeared 3 weeks later with ulcers, treated and advised to return 2 days later.......didn't show....documented...............1 month later lost toe................and apparently thought it was my fault.
    notes went to solicitor .................and the whole thing went away..........documentation the big key.
    doesn't stop you feeling sick about the whole thing, but this guy is just a bully. ignore his bullying and just be pleasant to him.
    hope it has a happy ending.
    unfortunately it doesn't stop him bad mouthing , but goes away with time.
     
  18. If there is one thing I have learned in over 29 years of practice is that those podiatrists who document their office charts neatly, legibly and thoroughly, including the things that have been mentioned by others in this thread, there will be very little incentive for a plaintiff's attorney to take on a malpractice case for a patient who thinks they have been harmed by a podiatrist.

    I dictate all chart notes of surgical patients very thoroughly so that my office notes come back very professional looking. Why do I make them professional looking?

    For myself? No.

    For another doctor? No.

    I dictate all my surgical notes only so that if an attorney gets a copy of my chart notes because a patient is unhappy with their surgery for whatever reason, they will see that my office notes are so meticulous that they won't stand a snowman's chance in Hades of showing, in court, that I was somehow a sloppy or careless podiatrist and that is the reason that their client was "harmed".

    Believe me, I've had enough experience in the medical-legal area to know that plaintiff's attorneys are looking to see if the podiatrist's chart notes properly, and legibly, document surgical consent, document possible complications,document advice given, document missed office appointments, document possible life threatening potential of their noncompliance, etc before they are going to take their time to try to prosecute a podiatrist or not.

    Document, document and then document some more....you will rest very well at night because of it...and the plaintiff's attorneys will hate you for it.:cool:
     
  19. Elizabeth Humble-Thomas

    Elizabeth Humble-Thomas Active Member

    In order to treat our patients effectively, to get rid of pain and remove pressure lesions we use scalpels (sharp!) We are working on tiny lesions. In order to achieve relief for the patient we work in microns of accuracy. The difference between ineffective 'safe' treatment, and effective lesion removal is minute. I accept the occasional haem as absolutely normal, and in no way careless (under operating is far more careless surely?) If cleaned and dressed there will be absolutely no problem. When I have dental treatment I almost always have some bleeding, even at the hygienist. What possible reason could this horrible man have to sue?
     
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