Summary
When Mrs C joined the medical practice, she met the practice manager and expressed concerns about her experiences with her previous practices. In particular, Mrs C was concerned that the abbreviation 'DNR' was in her medical notes, as she believed that this related to a 'do not attempt cardiopulmonary resuscitation' order (a decision taken that means a doctor is not required to resuscitate the patient if their heart or breathing stops). The practice manager told Mrs C that in her records DNR stood for 'diabetic nurse review', and followed this up with a letter explaining, amongst other things, that there was nothing anywhere in Mrs C's medical records about not attempting cardiopulmonary resuscitation. Mrs C acknowledged that she had spoken inappropriately to the practice manager in a phone conversation, although she had apologised for this afterwards. Following a consultation the next month, the practice then decided to warn Mrs C about her behaviour. Before they could do this, Mrs C wrote to them seeking clarification about issues arising from her clinical notes. The practice then wrote back saying there had been an irretrievable breakdown between her and the medical and management staff, and asked the health board to remove her from their list.
Mrs C complained about the way the practice responded to her complaint and the way they removed her from their list. We found that it would have been reasonable for them to have warned Mrs C before removing her, and that they did not explain why they did not do so. We upheld her complaint about this, and made recommendations. We also took independent advice from one of our medical advisers regarding the practice's explanations about the queries arising from Mrs C's medical notes. As we found that these were reasonable we did not uphold Mrs C's complaint about this.
Recommendations
We recommended that the practice: review their practice and processes in relation to removing patients, including training for staff where appropriate; review their practice and complaints processes, including training for staff where appropriate; and apologise to Mrs C for the failures this investigation identified.
Related reading
View Decision Report 201401246 as a PDF (13.37 KB) Updated: March 13, 2018