Medical Error with Angry Parent and Glass Foreign Body in Child's Foot

Summary:

This scenario involves addressing a medical error where a child with a glass foreign body in the foot was misdiagnosed and discharged without appropriate treatment. The key tasks are managing the angry parent, acknowledging the error, and ensuring patient safety through proper diagnostic and management protocols.

Key Points:

Data Gathering:

• Patient Identification:

  • Confirm full name, age, and first line of address.

• History Taking:

  • Sequence of the injury and its progression.

  • Allergies and vaccination status (specifically tetanus).

  • Medications and pain relief effectiveness.

  • Red flags like signs of infection (fever, redness, swelling).

• Incident Details:

  • Clarify the role and responsibility in interpreting the X-ray.

Diagnostic Approach:

1. Reassess the injury to ensure no complications.

2. Review the X-ray thoroughly to identify missed findings.

3. Examine for signs of infection or retained foreign bodies.

4. Determine if additional imaging or tests are required (only if clinically justified).

Management:

• Immediate Steps:

  • Apologize and acknowledge the error transparently, as per the professional duty of candour.

  • Remove the glass foreign body promptly.

  • Administer stronger pain relief if needed.

  • Address tetanus immunization status and provide a booster if required.

• Safety Netting:

  • Educate the parent on infection signs to monitor.

  • Provide clear instructions for follow-up if symptoms worsen.

• Follow-Up:

  • Arrange a follow-up visit to reassess the wound and ensure healing.

  • Document and report the error as per incident reporting protocols.

Communication Skills:

• Empathy and Validation:

  • Acknowledge and validate the parent's feelings of anger and concern.

  • Use phrases like, “I understand how upsetting this must be for you.”

• Clear Explanation:

  • Explain the process of resolving the issue and what to expect in simple terms.

• Transparency:

  • Admit the mistake, and outline measures to prevent recurrence.

Ethical Considerations:

• Duty of Candour:

  • Acknowledge responsibility and apologize sincerely without deflecting blame.

• Confidentiality:

  • Discuss the case and incident reporting within appropriate professional boundaries.

• Team Involvement:

  • Ensure senior involvement in handling the situation to reassure the parent.

    
    

Additional Resources:

• Good Medical Practice (GMC):

  • Guidelines on being open when things go wrong​.

• PLAB Exam Guidance:

  • Examiner tips on handling angry patients and medical errors effectively​​.

Important Considerations:

• Never assume a team or system error absolves individual responsibility for diagnostic oversight.

• Avoid over-promising or committing to unnecessary tests/resources.

• Time management is crucial to address all concerns while adhering to the station time limit.