Doctor in trouble—a service committee hearing

The mistake was absurdly simple, caused great mischief, and was none of my doing. One Saturday night I was called to an inner city probation hostel to see an ex-athlete with a chronic tear to a thigh muscle. The patient complained of much pain and said that he was already taking paracetamol and “di-something” but was vague and unhelpful about the details.

Medication is locked away at the hostel as the misuse of drugs (such as diazepam, dihydroco-deine, and even diamorphine) is widespread. The warden produced the paracetamol and cephradine from a cluttered safe, so I prescribed the anti-inflammatory drug diclofenac (Voltarol), having supplied a dose from my bag.

Three days later the surgery received a furious telephone call. The patient claimed that I had attempted to kill him by giving him a double dose of diclofenac (Voltarol) and promised legal action. He had previously been prescribed diclofenac in hospital and had a box of this at the back of the safe. He had not obtained the script for several days, and a staff member had spotted the duplication before any had been taken. I hastened round to check that he was all right, but he refused to see me or consider our in house complaints procedure, and announced that he would sue me.

A complaint to the family health services authority followed. Despite my having worked closely with the hostel staff for 15 years, there was a major contradiction between my written explanation and that of senior staff, who denied all responsibility. This was strange as the warden concerned had telephoned to apologise. A formal hearing was therefore inevitable. During the next five months more enjoyable work including audit and research ceased. My thoughts strayed on to the case while seeing patients or trying to sleep, and my wife worried too.

The committee consisted of three general practitioners (one retired and one private) and three lay people. The hearing took place after lunch on a warm afternoon. The attention of the more elderly members or the panel seemed to wander at times and one seemed to fall asleep. My impression was that my clinical records were scanned rather perfunctorily, and any attempt to discuss points with the panel was met with silence. What I felt was animosity in the questions and body language of some of the panel members. I did not feel that I was being impartially judged by my peers.

I have attended the crown court as a witness in murder trials and I was surprised by the contrast between the focused questioning of barristers and the quasilegal efforts of the service committee. As the proceedings are inquisitorial rather than adversarial it was hard to judge which way each point went or to test the logic of decisions reached—those asking the questions also deciding the verdict. Although there are 72 drugs in the British National Formulary starting with “di,” should I not have realised that my patient was describing diclofenac, even if I wasn't shown it?

The five month wait had done nothing to calm my ex-patient, who shouted angrily during my testimony. After two and a half hours the chairman concluded the hearing, and courteously apologised to the patient for the stress and disruption caused by the delays. I waited in vain for some similar remarks to myself.

A month later I was perplexed to hear that I “had not put myself in a position to establish the complainant's drug regime,” and I was instructed “to comply more closely with my terms of service.” My partners decided not to continue to work with the hostel and resigned from the advisory committee.

I do not accept the committee's reasoning and feel that the only honest course of action is to appeal, which takes another year.

The service committee procedure started in 1947 as neither complaint nor disciplinary procedure, but was aimed at enforcing the terms of service. In today's culture patients are consumers, and complaints are encouraged by the patient's charter as a way of improving the system.

But doctors are consumers too, and we expect more democratic treatment rather than the proposals in the Wilson report on complaints procedure with more delays and less professional input. I resent the fact that I have been blamed for this mistake and that the service committee had no inkling of the problems of inner city general practice. If I cannot respect this tribunal then their verdict is irrelevant, their efforts are counter-productive, and their admonishment will have been in vain.—STEFAN CEMBROWICZ is a general practitioner in Bristol