TEALE FENNING

Nick Raine-Fenning · Posted: Thu Nov 09, 2006 2:51 pm Post subject: Who is to blame?

You are asked to see a couple whose child died in labour. The CTG was very poor and a FBS showed a pH <7.20. A caesarean section was undertaken but only 40 minutes later and the baby was stillborn and unresuscitable. Furthermore the caesarean was conducted under regional anaesthesia.

The couple are very angry and ask ...

Quote:

Clearly there was some mistake here. Why did it take so long to deliver our baby? Someone is to blame - who is that?

What are you going to say to them?
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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Srin · Joined: 06 Nov 2006 Posts: 5 Location: Nottingham

I am very very sorry for your loss . I cant imagine how you both must be feeling at this time. All I can do is promise that the events that occurred during your labour will be thoroughly investigated.

Sorry - Its a tough one Sad

Nick Raine-Fenning · Posted: Sat Nov 11, 2006 9:57 am Post subject:

Good.

I suggest you start by saying ... "I am sorry that we are meeting under such circumstances"

Make sure the patient / couple know the circumstances are bad! We had someone say this to me when they were breaking bad news about a cervical biopsy Shocked

This line is to be used when the bad news has already been broken as in this situation.

The other thing you have to do here is to mention "statements".

Regardless of whether you have or have not been involved in the case it is important to ensure the patient / couple know the events will be thoroughly investigated (as you rightly suggested). The way to do this is to tell them statements will be requested from every member of staff involved in the case. A meeting, involving senior staff and hospital representatives, will then take place and the results of this will be presented to the patient / couple. This will be transparent and if a mistake has occurred they will be informed of this.

Clear??

Very Happy

Nick Raine-Fenning · Posted: Sat Nov 11, 2006 9:58 am Post subject:

What do you do if they ask who is to blame and it appears pretty obvious the SpR messed up?

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

even if it is clear where the mess up was, the explanation should be that mistakes if any will be communicated to the couple once the case has been studied by the investigating team.

am i right?
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Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Sat Mar 10, 2007 11:15 am Post subject:

Yes

The key here is not to be defensive. Tell them that there will be an enquiry which will involve a team of people and be lead by senior colleagues including the consultant of course. Statements need to be obtained from all parties involved and these will then be assessed by the team. Once that information has been collated and considered the couple will be seen and the findings discussed. Any errors will be identified and the couple will be informed. The whole process will be transparent.

The trick here is to remember that you are on the side of the couple. You are their friend - this is true for all OSCE stations.

However, it is essential not to admit blame and yet not to be defensive. Be a politician and keep repeating the above advice promising the couple you will do everything possible but that it would be inappropriate to make detailed comments without the full information.

Easy Wink

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"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

Abik · Posted: Sat Mar 10, 2007 2:55 pm Post subject:

Hi guys
This is excellent stuff!
I love the way it straddles four months - what a sar you are Nick, the forum is a resounding success. I am just about to talk through OSCE stations with an SHO for the crap MMC interviews - I will be stealing all your advice and totally claiming it as my own!!!! Wink

Anyone who doesn't use this site is a moron!