Medico-legal: Dealing with unscheduled patients

Take a detailed history if asked to see an extra patient outside the surgery, says Dr John Holden of the MDU

One of the pleasures of general practice can be the sheer diversity of conditions that patients may present with during a working day. However, there are occasions when unexpected and unscheduled patients can cause problems if the situation is not carefully handled.

Records

A common scenario where GPs may be asked to see an unscheduled patient is during nursing home visits when GPs may unexpectedly be asked to see other residents who are patients of the practice. These situations can present dilemmas for GPs who do not wish to refuse to see patients, but may also feel inadequately prepared for a consultation in circumstances where they have not consulted the patient’s computer records in advance, or have no immediate access to the paper records.

In situations where you are unfamiliar with a patient’s medical history, it is especially important to take a detailed history, including checking if the patient has any drug allergies. It is also important to make a clear, accurate note of the consultation in the patient records — ideally at the time of the consultation, or if this is not possible, soon after seeing the patient.

Home visits

When on home visits, you should make a contemporaneous paper note immediately after the consultation and transfer this to the computer records as soon as possible. When you are able to check the patient’s record, you should double check the patient’s history in case this would alter any aspects of the advice you have given.

Good records should be written legibly, should include the time and date when the contact occurred and should be signed with an identifiable signature. If there is a gap in time between the consultation and when the notes were written up, this should be noted and a reason given, for example a home visit.

Keeping good records

Records are primarily intended to support patient care and should accurately represent each and every consultation, not just in the surgery, but also telephone contacts, emails and home visits. They form the basis of good communication between doctors and other members of the healthcare team and serve as a reminder for doctors at a later stage. Notes will also help clarify the situation when investigating or responding to a claim or complaint. In the MDU’s experience poor, incomplete or absent records will frequently give rise to difficulties.

As the average delay between an incident and the claim coming to court is three or four years, a dated and timed note will also be invaluable in clarifying a sequence of events that might have occurred many years before.

While consultations with patients frequently throw up unexpected situations, you should be conscientious when it comes to making notes about all consultations.

Dr Holden is a medico-legal adviser at the Medical Defence Union

Learning points

Follow these steps when faced with a surprise patient

Unexpected and unscheduled patients can cause problems if the situation is not handled carefully.

You may not wish to refuse patients, but you may also feel inadequately prepared.

If you are unfamiliar with the patient’s medical history, you should take a detailed history.

Do not forget to check if the patient has any drug allergies.

Make a clear note of the consultation, with the date and time, and make sure that you transfer the details of the consultation to the patient’s notes as soon as possible.

Sources

www.rcgp.org.uk

www.the-mdu.com

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