A patient is angry about the apparent ill-treatment of her mother while in hospital. What should you do?
Jane came to see me about her 88-year-old mother, Edna, who lives with her and has Parkinson's disease with mild cognitive impairment.
A week ago, I visited Edna at home and sent her into hospital with what I thought clinically was bronchopneumonia. Three days later she was discharged with an antibiotic but without a discharge letter.
Jane told me that the hospital nurses caring for Edna had not fed her, had accused her of laziness when she asked for help to walk to the toilet, and had left her lying overnight in soiled sheets. As a result of the latter Edna had developed a sacral decubitus ulcer.
Jane also told me that the doctor had insisted that there was nothing medically wrong with Edna to justify my decision to admit her.
Jane plans to complain to the trust's chief executive and to speak to the local radio station. She wants me to give my support in public.
I have recently had other patients complain about the standard of nursing care in that particular ward. What should I do?
A GP'S VIEW - LOUISE WARBURTON, GP IN IRONBRIDGE, SHROPSHIRE
Sadly this dilemma sounds like the experiences of many hospital patients today.
I think it is inadvisable to become involved in Jane's personal fight on behalf of her mother. We as GPs should be seen to be impartial and should not act on behalf of one of our patients in a personal dispute with the hospital trust. It would also be foolhardy to appear to be supporting Jane, especially if she is going to go public on a radio station. If your name as her GP is linked with her complaint, it could make relationships with the hospital very difficult.
However, the lack of a discharge letter is something that you could take up with the trust chief executive and so indirectly draw his attention to the standards of care on this particular ward. The development of a pressure ulcer after only three days in hospital does indicate extreme lack of nursing care.
Personally, I would also speak to the medical director of the hospital and raise my concerns about the attitude of the doctor who told Jane that there was nothing medically wrong with her mother. This shows a singular lack of clinical skills and respect for patients. I would also raise the problem of the absent discharge letter.
Something needs to be done about the standards of medical and nursing care on this ward, but it can be done sensitively without compromising your professional reputation.
A MEDICOLEGAL OPINION - DR DES WATSON, MEDICOLEGAL ADVISER AT THE MEDICAL PROTECTION SOCIETY
First, you should explain to Jane why it is inappropriate for you to become personally involved in a complaint about which you have no direct first-hand knowledge and provide her with information on the NHS complaints procedure.
Second, if you have reason to believe patients are receiving substandard care, you should raise this with the medical director of the hospital and seek confirmation that this will be appropriately investigated and any necessary steps taken. It might reassure Jane to know that you will be writing to the director, without disclosing the other complaints to her.
Finally, Jane's comments raise the possibility of criticism by the hospital doctors about your treatment and referral. While legitimate comments by hospital doctors can be taken out of context and misinterpreted by disgruntled patients or their relatives, you should address any concerns about your decision to admit directly with Jane. Obtaining consent from Edna is probably not an issue here bearing in mind the cognitive impairment.
You must, of course, continue to provide good clinical care to Edna as your patient.
A PATIENT'S VIEW - AILSA DONNELLY, PATIENT PARTNERSHIP GROUP
Doing nothing is not an option. However, you cannot support Jane based just on reports from her and others - you need to do your own investigations.
A useful starting point might be to contact the hospital doctor involved, both about the lack of a discharge letter and to discuss the appropriateness of the admission. This would also be an opportunity to seek further information about the appearance of the ulcer.
It is unclear if you mentioned Edna's Parkinson's disease and cognitive impairment when referring.
It might be possible to make discreet enquiries regarding the standard of nursing care in the hospital. If conditions are as bad as they appear, then hospital staff are likely to share Jane's concerns.
Once the facts have been determined, you must decide the extent to which you wish to be involved. For you, formal channels of complaint might be more appropriate than going through the media. For Jane, the local patient advice and liaison service and the hospital complaints manager could be an appropriate first step. This might remove any need for any further action.
You might also consider giving Jane's contact details (with her permission) to other complainants so that they can present a united front.