Historically, general practitioners (GPs) have been regarded as having particularly trusted and close relationships with their patients, which likely contributed to the relatively low number of medical negligence claims against them. However, the traditional model of the “family doctor” has become less prevalent, with patients now often registered with a practice rather than a specific GP. Further, patients are also increasingly seeking care through walk-in clinics or the rise in telemedicine. The traditional in-person or face-to-face consultation with a GP is no longer the sole method of accessing general practice services in Malaysia.
Indemnity
Since 2019, it has been compulsory for all practicing doctors in Malaysia, including GPs, to hold professional indemnity insurance in order to renew their Annual Practicing Certificates (APC). Section 20 of the Medical Act 1971 makes it compulsory for all doctors to produce evidence of professional indemnity cover when applying for their APC. This ensures that all registered GPs are adequately protected against medicolegal claims.
Common Causes Of Medical Negligence Claims Against GPs
Some of the common causes of medical negligence claims against GPs include:
1. Misdiagnosis or Delayed Diagnosis:
Failing to correctly diagnose a condition or delaying the diagnosis (see Wright v Cambridge Medical Group (a Partnership) [2013] QB 312).
2. Medication Errors:
Prescribing the wrong medication, incorrect dosages or failing to account for drug interactions can result in adverse effects or ineffective treatment.
3. Inadequate Examination or Investigation:
Failing to conduct thorough physical examinations or failing to order necessary tests.
4. Poor Record-Keeping:
Inadequate or inaccurate documentation of patient consultations, treatment plans or medical history can lead to errors in ongoing care and difficulties in defending against medicolegal claims (see Dr Wong Chuen Yeen v Thivagar Bala Ratnam [2023] 1 LNS 582).
5. Failure to Refer to Specialist:
Delays in referring patients to specialists or secondary care can exacerbate conditions, particularly in cases where timely intervention is critical (see Shaw v Stead [2019] EWHC 520 (QB)).
6. Lack of Consent:
Failing to properly inform patients about the risks, benefits, and alternatives to treatment before proceeding can lead to medicolegal claims.
7. Administrative Errors:
Administrative errors, such as mishandling patient records, misfiling results, or failing to act on test results, can contribute to medicolegal claims.
8. Red Flags:
Failure to identify and failure to refer when red flag symptoms are present.
9. Communication Failures:
Miscommunication between the GP, patient, or other healthcare providers can lead to misunderstandings about treatment plans, contributing to poor outcomes (see Mccabe v Moore And Others [2015] EWHC 260 (QB) and Loo Chooi Gaik v Dr Loh Lay Soon [2019] 4 CLJ 281).
10. Failure to Provide Adequate Safety Netting:
Failing to give patients clear instructions on when to return for further consultation if symptoms persist or worsen can result in delayed care and adverse consequences (see Yeo Peng Hock Henry v Pai Lily [2001] SGCA 72).
Communication
Effective communication skills including the ability of a GP to elicit information from a patient and clearly explain medical conditions and treatment plans, are fundamental aspects of a GP's role.
Medical negligence claims against GPs frequently arise from instances where a GP fails to obtain crucial information, either by neglecting to address a symptom that was mentioned or by not asking the appropriate questions to uncover that symptom. These allegations often involve factual disputes regarding who said what and who asked what, making them matters for the court to resolve. GPs are advised to thoroughly document these conversations in the patient's medical records.
Record Keeping
The standard of record-keeping has evolved significantly over time. It was once common to find brief, handwritten notes made by GPs, often consisting of just one or two lines. With the advent of computerisation, the ability to accurately code diagnoses and document examination findings has improved, and templates for common medical conditions have become more widely used. GPs are encouraged to document both positive and negative findings.
The MMC Good Medical Practice 2019 Guidelines (MMC Guidelines) states that patient cards and electronic records should contain all relevant information, physical findings and diagnosis in the course of patient management. Such records should be accurate, legible, comprehensive, honest, non-judgmental and up-to-date, and contribute to easy recall of patient information for continuity and follow-up of patients, as well as for future reference such as preparing reports or insurance forms.
Chaperones
The MMC’s Guidelines stipulate that a doctor must examine a patient of the opposite gender, or a child, with a chaperone being physically present in the consultation room, with visual and aural contact throughout the proceedings. The MMC also states:
(i) A relative or friend of the patient is not considered a suitable chaperone.
(ii) If a patient requests to have a consultation in private without a chaperone present, the doctor must respect this request and make a note of it in the patient’s medical record.
(iii) In cases where a chaperone is unavailable or not provided, the doctor must inform the patient of this and arrange for one if the patient requests or insists on having a chaperone present.
These guidelines are designed to ensure that the doctor can conduct a thorough and unobstructed clinical examination of the patient as deemed necessary for an accurate diagnosis
Safety Netting / Post Consultation Advice
An essential component of safe and effective consultations is providing safety netting for the patient. This involves giving specific follow-up advice or guidance on symptoms that, if they develop or persist, would necessitate the patient returning to the GP. It is generally advisable for GPs to document the safety netting advice provided to the patient. In certain clinical conditions, such as cases of sepsis or chest pain, the quality of safety netting advice becomes particularly critical (see Yeo Peng Hock Henry v Pai Lily [2001] SGCA 72).
Conclusion
The role of GPs in Malaysia has undergone significant changes. In this evolving landscape, it is imperative for GPs to be vigilant about their medicolegal responsibilities to ensure both patient safety and professional protection. Key areas of focus include maintaining comprehensive and accurate medical records, effective and clear communication with patients, obtaining proper consent, and adhering to guidelines regarding chaperone use and safety netting advice. Awareness of common causes of medical negligence claims, such as misdiagnosis, medication errors, and failures in timely referrals—is essential for mitigating risks.
By prioritising these medicolegal essentials, GPs can enhance the quality of care provided while minimising the likelihood of medicolegal implications. Being proactive, rather than reactive, is key to safeguarding your practice.
24 September 2024
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