Practice Dilemma - Prescribing error by a neighbouring practice

Your elderly patient falls and burns himself on a radiator because he could not move. Before his fall, the patient was supposed to be taking amitriptyline 10mg at night for pain and as a mild sedative. However, when staying with his daughter in a nearby town he was prescribed 50mg, which may have caused his fall. His daughter has made a complaint to her own practice, which made the error, and wants you to write a supporting letter. What should you do?

Obtain the patient's consent before providing clinical information (Photograph: SPL)
Obtain the patient's consent before providing clinical information (Photograph: SPL)

A GP's view - Dr Judy Duckworth is a salaried GP in Cornwall
First, I would clarify whether the official complaint was made by my patient or his daughter. Before providing any clinical information, I would need to obtain the patient's consent.

The daughter may feel that a letter supporting the complaint will influence the outcome. Her own practice should investigate the matter, adhering to the formal complaints procedure.

Unless I have records of the medical care he received before the injury, I am unable to comment on the cause of his fall. A higher dose of amitriptyline may have caused it, but was not definitely responsible; falls in elderly people are frequently multifactorial.

The other practice may have made a prescribing error, but it is also possible that my own practice altered the patient's repeat medication and an incorrect dosage was subsequently requested. I would review his clinical records, looking for changes initiated by my practice or by secondary care.

I would invite the daughter to attend surgery with her father to discuss their concerns and expectations, while explaining the constraints of patient confidentiality. I would offer my support in his care. With his consent, I would be willing to issue a statement detailing his prescribed medication, but I would not be willing to comment on his care.

A medico-legal opinion - Dr Rob Hendry is head of medical services, Medical Protection Society
When a prescribing error has apparently been made, the GMC states that the patient and family have a right to expect a prompt, constructive, honest response to any complaint. This would include an explanation of how the matter arose and, where appropriate, an apology.

In this case, it would be most appropriate for the complaint to be dealt with by the practice that made the error. You do not know the whole story, so it is unlikely to be helpful for you to become involved.

When asked to comment on colleagues' actions, it is important not to make unfounded criticisms; it is unprofessional and can undermine patients' trust in their care.

It would be helpful for you to advise the patient and his daughter about how the NHS complaints procedure works. You should encourage her to engage with the neighbouring practice in a constructive way to understand how the error happened and how they can avoid similar errors in future. There may also be learning opportunities for your own practice with regard to how information about patients' medication is shared with other prescribers.

A patient's response - Elizabeth Brain is an expert patient
An immediate letter of support would be inappropriate until the facts of the matter are clear. It would be advisable for you to invite the patient's daughter to a discussion with you where all the facts can be presented and questions asked.

These might include: Why did your patient attend the daughter's practice? Did her father run out of medication or did he present with other symptoms? Did her father take his medication container to the surgery? Did the GP attempt to contact you before prescribing? Did the GP know your patient's history or warn the father of possible side-effects? What general care did the daughter take to monitor her father while he was with her? Did she check the prescribed dose and query it with the GP or pharmacist?

If the GP has apparently proceeded without due care, a discussion might be needed before you take any action. Only then will the right course of action become apparent.

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