Practice dilemma - An undignified death

Your partner dealt with the death certificate and cremation forms. A few days later, the patient's angry son comes to see you. He had found out that because the partner did not want to go to the undertakers to view the body for cremation certificate purposes, he had it brought to the surgery car park and performed the examination there. The son was appalled that his father's body had been subjected to what he felt was an undignified excursion. He wants an apology from the partner, reassurance it would not happen again, and is considering making a complaint and going to the press. What should you do?

Explain to the son that his concerns will be taken seriously (Photograph: Jason Heath Lancy)
Explain to the son that his concerns will be taken seriously (Photograph: Jason Heath Lancy)

A GP's response
Dr Judy Duckworth is a salaried GP in Cornwall

If the son's account is accurate, my partner's actions were inappropriate, raising concerns about confidentiality and respect. I would allow the son time to ventilate his anger, and explain that his concerns will be taken seriously and investigated thoroughly. I would offer my condolences for his loss and express my regret for this additional distress.

It is important to establish the facts, including the identity of any witnesses. I would clarify exactly what outcome the son is seeking as a result of his complaint. Hopefully, this approach will avoid a formal complaint or involvement of the press. I would explain the procedure for making a complaint, should he decide to take it further.

In order to obtain an accurate picture of events, it is necessary to speak to everyone involved, including my partner and the undertaker, as the incident may have been misconstrued. If a designated partner or the practice manager usually deals with complaints, I would involve them before taking any further action. Were there unusual circumstances which led to my partner's actions, such as excessive workload or lack of locum cover in my absence? Is my partner unwell or stressed and in need of support? Were there prior concerns about his fitness to practise?

Advice should be sought from a medical defence organisation, and the practice will need to review future policy. A further meeting with the son should be arranged and, should the complaint be validated, a written apology provided.

A medico-legal view
Dr Jonathan Bernstein is a medico-legal adviser at the Medical Protection Society

You should offer the son a sympathetic response including an apology for the distress experienced. You should address the issue with your partner as soon as possible.

The partner should be encouraged to respond in an honest and empathetic way. While this may have been a perfect solution to an otherwise unworkable day he should show understanding about how it could be seen by the family. He needs to be open and accountable for his actions, taking responsibility for the decision he took.

There may have been overriding factors as to why he had asked for the body to be brought to the surgery. He should explain if he had considered alternative options. If he believed the family knew of and understood the situation he may explain the basis for this. He should emphasise that should such a situation occur again he will seek to avoid the distress caused by having a full discussion with the family in advance.

He should apologise personally if, with the benefit of hindsight, he feels that there was an error of judgment or misunderstanding and for the impact this has had on the family. Such an approach is more likely to reduce the risk of the matter escalating than a defensive response.

If the circumstances surrounding the incident have identified the need for changes in procedure then the family should be made aware of the action being taken. The doctor could ask the family if there is anything more that can be done to alleviate their distress.

Bear in mind that should the matter become a complaint the Parliamentary and Health Service Ombudsman's Principles for Remedy does include the possibility of financial remedy if the family have suffered additional distress as a result of maladministration or poor service.

A patient's opinion
Danny Daniels is an expert patient
Even though the actions of the partner may not have infringed any established codes of practice, there does appear to be cause for concern.

From an ethical standpoint it would appear that the partner has jeopardised his own professionalism and the integrity of the practice.

Talk to the partner and review all the circumstances relating to the death of the patient and your partner's subsequent actions in order to verify that all correct procedures were adhered to. Aim to establish why the examination took place in the car park and whether ethical standards were breached.

A significant event report should be carried out and the practice's complaints procedure should be followed. It may help to arrange a meeting with the son and your partner, with an independent mediator attending, in order for the partner to explain his actions and offer his apologies if necessary.

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