On Good Medical Practice #2
Summary
During my quest to find treatment for my facial pain, I have been stunned by many medical consultants, have, in my opinion, deviated from Good Medical Practice. I have seen over fifty consultants across 15 different NHS Trusts. It would not be possible to cite all of the examples. I will cite a cross-section of examples of deviation of Good Medical Practice, which span across its four domains.
Deviation Example 1
I saw a Head and Neck surgeon at an NHS Trust in Scotland, regarding my left sided facial and peri ocular pain. He promised to do a set of new scans, discuss my case at a Multi-Disciplinary Team meeting, and refer me to ophthalmology and Infectious Diseases. He told me that he would see after the scans, to ‘find a way forward.’ After I had my MRI and CT Neck scans, I received a letter from him saying, that he wanted to explore the ‘pain management’ route. Weeks and months went by. The consultant made no contact with me. I wrote to him three times, and asked for a follow up appointment. I did not receive a reply. There was a long silence.
He referred to me to a Pain Management team, who wrote back to the surgeon to say that they could not accept me onto their service, because ‘I was not suitable for their service.’ The surgeon referred me to an Infectious Diseases consultant, who saw me once. My infection markers: neutrophils and white blood count, were both raised in the blood tests that the Infectious Diseases Consultant did. However, he discharged me, in spite of these abnormal raises. He left me with no follow up care or treatment.
Dead End
There was no contact from the Head and Neck surgeon for eighteen weeks. I heard nothing from him, so I wrote to the NHS Trust, and I explained to them that I had not been given a follow up consultation with the surgeon. I received a letter from the NHS Trust, saying that I needed to be seen by Pain Management. The NHS Trust wrote this letter to me in knowledge that the Pain Management service had rejected the surgeon’s referral. They sign posted me back to a service, who they knew had declined to see me. I was led down a dead end.
Three clinical teams; Infectious Diseases, Pain Management and Head and Neck surgery, all declined to help me. They gave me no adequate explanation as to why. I had three doors shut on me, when clinical data: scans and blood tests, were available, and which showed that there was something clinically wrong. They overlooked this clinical evidence and left me with no care. I found this difficult to understand.
Communication, Partnership and Teamwork
Good Medical Practice states that a doctor ‘must’
(3) 31 Listen to patients, and respond honestly to their questions.
(3) 32 Give patients the information they want or need to know in a way they can understand.
I wrote to the Head and Neck surgeon, four times asking him questions about the scans. I received no reply. The same applied with the Infectious Diseases consultant; I wrote to him, and asked what the abnormal raises with my neutrophil and white blood count indicated. He did not respond to me either. Neither of them ‘answered my questions honestly’ or ‘gave me information that I wanted and needed to know about my condition.’ Both instances seem like a clear departure from Good Medical Practice.
Good Medical Practice states that a doctor ‘must’
(3) 35 Work collaboratively with colleagues, respecting their skills and contributions
(3) 44.a Check, that a named clinician or team has taken over responsibility when your role in providing a patient’s care has ended.
There was no collaboration between these clinical teams. The Head and Neck surgeon knew that Pain Management had refused to see me, yet he signposted me back to them. The surgeon was also aware that Infectious Diseases had discharged me. He closed my case, without ensuring that there was anyone to take over my care. He ghosted me for twenty-four weeks. It was painful. His behaviour made me feel insignificant and invisible.
Deviation Example 2
I recently published two blog posts, in which I spoke about consultants, who made offensive comments to me and spun the truth, when I asked them about radiology images. One consultant told me to ‘stop shopping around.’ Another told me to stop ‘chasing the dragon.’ I asked an Oral Maxillofacial consultant to explain visible facial asymmetry in a CT scan. He answered by telling me that the quality of my iPad was s**t.
A third Oral Maxillofacial surgeon told me that the asymmetry in the scans was because my face ‘was lopsided in the scanner,’ when he had not seen me go into the scanner. Another consultant told me that it was just ‘coincidence,’ that what I was seeing in the radiology image, was where I had pain. That same consultant then went on to photoshop radiology images, in front of me, so that the abnormality disappeared. It was beyond shocking.
Good Medical Practice states that a doctor ‘must’
Establish and Maintain partnerships with patients
(3) 46 Be polite and considerate
(3) 48 Treat patients fairly and with respect
(4) 65 Make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession
(4) 68 Be Honest and Trustworthy in all your communications with patients and colleagues
Their behaviour was not ‘polite’ or ‘considerate.’ I was not treated with respect or fairness. Their communications were not trustworthy, and their conduct failed to justify my trust in them as doctors, or in the profession at large.
Deviation example 3
I had an MRI Neck scan done at an NHS Trust in Yorkshire, in July, 2021. The radiology report states that abnormality has been detected. The abnormality found, relates to the Buccal Fat Pad and retromolar region, on the left side of my face. I have asked four different clinicians at the hospital, what the abnormality is. I have received no explanation. There has been no follow up in regards to explaining what this abnormality is, or treating the abnormality. I am in severe and worsening pain, and yet there is ‘evidence available’ on file, at a hospital, which shows that something is clinically wrong. Nobody has acted on it.
Knowledge, Skills and Performance
Good Medical Practice states that a doctor ‘must’
(1) 15 Provide a good standard of practice and care. If you assess the patient, you ‘must
b Promptly provide suitable advice, investigations or treatment
16 In Providing clinical care you must;
(1) b Provide effective treatments based on the best available evidence.
There is ‘evidence available,’ that there is an abnormal process going on in the soft tissue of my face. The NHS Trust have not ‘promptly arranged treatment,’ or ‘provided effective treatment based on the evidence available.’ I have asked what this abnormality is. They have not ‘responded honestly to my questions,’ or ‘given me information that I want and need to know.’ ( Good Medical Practice; 31 and 32)
I had a similar experience, when I was a patient at a salivary gland unit at an NHS Trust in London. They found, via ultrasound and sialography, that my salivary gland was not functioning properly. The clinic detected obstruction in my parotid gland. I was having saline wash outs, which they promised to do long term. However, they suddenly discharged me from the clinic, for no reason, and in spite of them having clinical evidence available that there was something wrong.
Deviation example 4
A recent blog post, The Ghosting of my General Practitioner, explains how nine different GP practices have sent out referrals, which have been refused or irresponsibly batted back to the GP. My current GP referred me to an Oral Maxillofacial department. They sent the referral back because the problem was too ‘complex.’ My GP was advised to send the referral to a named clinician a Teaching Hospital. He did this. We did not hear anything for months. I telephoned the hospital, and I was told that my case had been closed; that I had been discharged, without being seen. They did not inform my GP of the rejected referral. Again, this conduct was beyond shocking
Good Medical Practice states that a doctor ‘must’
(3) 35 Work collaboratively with colleagues, respecting their skills and contributions.
36 Treat colleagues fairly and with respect
44 a Share all relevant information with colleagues involved in your patients’ care within and outside the team.
For the Oral Maxillofacial department to not even inform my GP that they had rejected his referral is neither, ‘working collaboratively,’ ‘treating him fairly or with respect,’ or ‘sharing relevant information’ with him. This is a major divergence from Good Medical Practice.
Conclusion
I have attended 60 plus consultations over the last ten years regarding my left sided facial pain. I have over fifty letters, saved on my desktop, which I have written to consultants, asking questions about my condition. None of them have responded to me. The questions that I have been asking is a) why the oral antibiotics work up to a point, but when I come off them, my symptoms return, b) what the abnormal raises in my bloods indicate, and c) what the aetiology is behind my facial pain.
What I struggle with most deeply, is that there is clinical evidence available, which holds valuable information about the possible pathology behind my medical problem. However, numerous consultants ignore the data. The data, which I wish they had paid attention to over the years, are my blood test reports, which have shown raised infection markers since 2013. There have also been scan reports and histology reports, which have show abnormality, which have been overlooked. This seems to be a departure from Good Medical Practice, which states that doctors ‘must’ ‘provide treatment based on the available evidence.’
The Rejection Hurts
What has hurt the most, is the ruthless way that clinicians have shut my case down, before they have even met me. I have been perplexed why so many referrals have bene rejected and why I have been prematurely discharged from so many clinics, when there is ‘evidence available’ that there is a clinical problem. Throughout my entire ten-year battle to get treatment, most of the consultants who I have seen have discharged me after one appointment. They have not taken ‘all possible steps to alleviate pain and distress whether or not a cure may be possible.’ (Good Medical Practice, (1) (16 c) In fact, quite the opposite. Their dishonest and offensive behaviour has created more distress and further confusion.
Recommended Articles
The Ghosting of my General Practitioner
Good Medical Practice- GMC Guidance