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Episode 2

The one where Jane finds out things are not quite as simple as was thought…..

Before discharging Jane, the Emergency Department (ED) doctor, Dr Kerr types out a prescription for a Non-Steroidal Anti-Inflammatory (NSAID) pain relieving medication

Ep2 - NSAID3 Ep2 - NSAID2

because Jane has said she is in considerable pain. Jane has a previous history of stomach ulcers, which is an indication against NSAID use. The computer system being used in the ED department issues a contraindication alert (an alert to advise against the use of this medication).

Ep2 - Drug Alert

Because the system frequently issues these alerts, often even for minor insignificant problems, it is has become common for the doctors to click through these alerts especially at times when it is busy. Satisfied that Jane has been adequately managed Dr Kerr discharges Jane with crutches and sends her home.

Ten days later, Jane’s ankle has not improved despite following the doctor’s instructions – in fact, it has become so bad that she has been going up and down stairs on her bottom. The joint is swelled, bruised, red and very painful, even though Jane has been taking the pain medication the doctor prescribed.

On top of this, Jane’s stomach has been extremely uncomfortable since she began taking the NSAID medication,

Ep2 - Epi Pain

and due to nausea, she has lost her appetite. Altogether, Jane is very unwell, and she is becoming very worried about herself. Jane contacts the family GP, Dr Dee, the next day to see if anything else can be done about her injury. The GP surgery is also very busy but the receptionist schedules Jane into an urgent for the end of the morning.

Ep2 - Dr Dee2

At the urgent appointment Dr Dee, who knows Jane well, listens carefully as Jane recounts the accident in full, particularly when she describes that she has never experienced pain of this magnitude before. Dr Dee performs a thorough examination of the injury and given the history and the clinical findings decides to arrange an X-ray at the local hospital. Before leaving the GP surgery Dr Dee advises Jane to discontinue the NSAID medication, on the assumption that it has been aggravating her previous ulcer disease, and prescribes an alternative pain medication as well as a medication to alleviate the symptoms in her stomach.

Later that afternoon Dr Dee gets a call from the hospital x-ray department (several hours later) and the radiologist reports that there is actually a fracture at the lower end of fibula – much worse than the sprain ruled out by the original diagnosis.

Ep2 - Fib Fracture

Due to the nature of the injury it is likely that Jane will need to be seen by a fracture doctor to consider whether surgery is required to repair the ankle. Jane is sent back to the A&E department where the original diagnosis was made to see a fracture doctor.

Upon arriving in A&E Jane is lined up for assessment by one of the fracture team. By coincidence it so happens that Dr Kerr, the original A&E doctor who assessed Jane, is working the same shift and recognizes Jane as she is brought into the department. Jane spots Dr Kerr but Dr Kerr pretends not to see her. Filled with curiosity though, Dr Kerr goes and looks up the notes from the original consultation and compares the notes being written for today’s consultation and realizes that she has made a couple of errors. She is naturally embarrassed by this and wondering whether she should say something decides that since she is again very busy that she ought to keep on working to ensure that work doesn’t get out of hand again today.

The fracture team decides that surgery is required and they schedule surgery for the following morning. Jane feels very upset that her concerns were ignored and that she now has to have surgery 11 days after the original injury. She is also annoyed that she was given medication that has upset her stomach. She feels very let down and thinks she will complain to the hospital.

Ep2 - Complaint

Jane is very upset with how things have developed.

Questions for Student Comment:

1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession

2. Is it just because errors were made or are there other reasons why Jane is so upset?

3. Suggest how the Patient Safety breaches in the case could have been avoided

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  24. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    The behaviour of the GP towards Jane is empathetic and the GP looks thoroughly through her medical records in order to make a fully informed medical diagnosis. This contradicts the A&E Doctor’s behaviour as they are rushed and do not appear to have time to listen to Jane’s concerns with the consultation being quite impersonal and so leads to an incorrect diagnosis. This will most likely lead to Jane developing a lack of trust for doctors in future as while the care she received from the GP corrected the mistakes made in A&E, she should have been correctly treated and listened to the first time around and to make matters worse the doctor in A&E didn’t apologise for their mistakes which would probably increase Jane’s lack of trust for health care professionals.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Irrespective of the mistakes made, Jane’s concerns were ignored in A&E when she stated that her pain was far worse than a sprain. As well as the errors made, the fact that Jane was ignored and her first consultation was rushed and impersonal definitely would have added to her frustration.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    More effective listening and communication between doctor and patient and not dismissing the patient’s opinion. Despite being under pressure and time restrictions, trying not to rush consultations and reading patient notes carefully.

  25. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession.
    The behaviours of these two doctors portrayed contrasting sides of medical practice; one where the patient was listened to and properly cared for and another where the patient’s concerns were disregarded, therefore further harming the patient’s recovery. Dr Kerr, the A&E doctor, was quite rushed during her consult with Jane and hastily conducted an examination, resulting in the lack of knowledge about Jane’s previous medical history, her allergies or intolerances and most importantly her concerns. Furthermore, by dismissing the automatic alert, the doctor further endangered the patient’s treatment, putting Jane in a worse situation than before. Not only did Dr Kerr’s actions have a long-lasting impact on Jane’s health but have also caused future mistrust in the medical profession due to the dismissive nature and misdiagnosis of the A&E doctor. In addition, upon seeing Jane again and recognizing her mistake and misdiagnosis, the doctor did not take the time to apologize to Jane which is not good medical practice. The GP however, took their time to listen to Jane’s concerns and thoroughly checked her history and performed a thorough examination. Moreover, the doctor was caring and scheduled an emergency appointment even though the practice was quite busy that day. The doctor noticed the NSAID was irritating Jane’s stomach ulcer and advised her to stop using it, instead prescribing a different medication for her pain. This would positively impact Jane’s perspective on the medical profession, where she was listened to and taken proper care of by a doctor following the Duties of a Doctor and the GMC.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    The errors made by the A&E doctor resulted in situations that may have caused Jane to become more upset. The way in which Dr Kerr handled her stressful A&E was detrimental to Jane’s health, resulting in her condition worsening due to easily preventable errors. Not only were her medical needs not listened to but Jane was not listened to causing her to lose her faith in the medical system. Moreover, due to NSAID which aggravated her stomach ulcer, she was in immense pain and unable to eat causing her to be more upset about her situation. In fact, had the A&E doctor been more attentive, Jane could have received the surgery much earlier saving her from the pain from her ulcer and a second trip to the hospital.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    The reason the A&E doctor did not know about Janes’s stomach ulcer was due to the automatic alert, which is normally considered irrelevant and therefore dismissed. In order to prevent this in the future, the system and its warnings should be altered to accommodate to flag more serious issues, thereby preventing doctors from incorrectly dismissing them. Moreover, doctors should take their time to ensure thorough examinations are taken and the patients concerns are properly listened to and considered. The patient should leave the consult, satisfied and hopefully on the path to recovery. To ensure that there is proper knowledge about a patient, a detailed history, which is easily accessible, should be communicated between a patient’s various doctors.

  26. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Dr Kerr would have likely caused her to mistrust the medical profession, due to his dismissive nature and misdiagnosing. This mistake could have had lasting impacts on Jane’s health, and so her mistrust would be understandable. However, due to the GP who had time to listen, check her history and make her feel more at ease, Jane would have reason to trust the medical profession. Overall she would have mixed feelings.
    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Dr Kerr seemed to have failed not from the diagnostic side, but also in the social aspect of making Jane feel more at ease, as he dismissed her concerns and appeared distracted as though Jane wasn’t his main focus.
    3. Suggest how the Patient Safety breaches in the case could have been avoided
    The staff on the ward should be spoken to about the computer system and it’s warnings, or the system should be changed so that only medication that will cause serious side affects are flagged up. The doctors should try to work through each patient as thoroughly as possible within the time limit.

  27. Anonymous says:

    Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Jane had two very different experiences. The GP was markedly more aware of Jane’s history and quickly realised that Jane had a serious medical issue. Also as the GP scheduled her an emergency appointment and validated her concerns Jane got the correct treatment and was able to see the fracture specialist. As a result Jane’s may trust the GP more readily than the Dr Kerr.
    Due to Dr Kerr being under a great deal of time pressure she missed some serious indications.Also Dr Kerr decided not to apologise which is not considered good practice. Jane may feel that Dr Kerr and the A and E department are incompetent as they did not bother to acknowledge her history of stomach ulcers and prescribed an unsuitable drug.
    Is it just because errors were made or are there other reasons why Jane is so upset?
    The main reason why Jane is upset is probably due to the fact that easily preventable errors were made and she only received appropriate treatment eleven days after her injury. She is also yet to receive an apology from Dr Kerr for a potentially endangering her health. Jane is also in considerably pain from the ulcer and has not eaten much.
    Suggest how the Patient Safety breaches in the case could have been avoided
    Dr Kerr could have checked the records more carefully instead of assuming that the drug alert warning was nothing. Also Jane’s concerns should be listened to as the patient will know what level of injury they have based on their own experience.

  28. Anonymous says:

    1. Both doctors displayed markedly different behaviours towards Jane’s care. Jane’s view of the medical profession may have been tarnished by her interaction with Dr Kerr who seemed to dismiss her presenting complaint as something not requiring a great deal of attention. Dr Kerr after making a mistake should practise with openness and integrity and instead of pretending not to see Jane returning to A&E, she should have approached her and hold herself accountable for aggravating Jane’s injury. Jane might have noticed Dr Kerr seeing her in A&E and would have some mistrust in the profession as she did not apologise for her mistake. . This encounter would make Jane realise that even doctors do sometimes get things wrong but for Dr Kerr to not apologise might make Jane not want to visit A&E again for fear of not being taken seriously. Jane’s encounter with Dr Dee on the other hand would give Jane a more accurate picture of how a medical professional practices. Dr Dee has known Jane for quite sometime and through regular visits has perhaps build up trust and a good doctor- patient relationship so Dr Dee must be aware of what concerns and expectations Jane has in terms of her intended health outcomes. Dr Dee took time to probe Jane about why she is at the GP surgery when performing a more thorough examination and reaching the conclusion her injury requires serious attention.
    2. Errors in her care may be one reason for her being upset but to determine other reasons why she may be upset requires a holistic approach to her care which was mostly implemented in practice when she visited Dr Dee at the GP surgery. It could be that if her concerns were addressed the first time she would not have been in such excruciating pain that she had to resort to moving on her bottom to use the stairs. She may be upset due to the frustration of no-one apologising for the lack of care she received when she was first admitted into A&E.
    3. Dr Kerr should pay more attention to what her patients are worried about, and strive to ensure their concerns are met. She should ensure adequate time is given for the consultation so that she is not rushing to move onto her next patient.. Also a faulty computer system resulted in Jane being given contraindicative medicine resulting in her having a stomach ulcer. Better monitoring of medications is required.

  29. Anonymous says:

    1 – The experiences that Jane, the patient, had with Dr Kerr in the A&E department and Dr Dee in the GP surgery show enormous differences, with Jane’s experience in hospital in A&E having negative impacts on her view in the medical profession, which might possibly have been restored upon her visit to the GP surgery. During the initial consultation, Dr Kerr was very was rushed due to the high pressure and stressful A&E working environment. Consequently, she failed to intently listen to all of Jane’s concerns and did not enquire any further information that may influence a history taking, a diagnosis and subsequently a treatment plan. This includes examples such as a detailed medical history and any allergies Jane might have to certain types of medication. In this way, Dr Kerr has shown a complete lack of care in their patient and has certainly not provided them with the best standard of quality healthcare. It is clear that Jane would have left the hospital appointment feeling incredibly dissatisfied with how the appointment went, and the lack of display of care and empathy that Dr. Kerr should have shown with Jane. This particular lack of care and lack of communication is in conflict with ‘Paragraph 31’ of the Duties of a Doctor as set out by the GMC stating, ‘You must listen to patients, take account of their views, and respond honestly to their questions’. The frustration and dissatisfaction that Jane would have experienced, in addition to her incorrect diagnosis will have reduced her trust and her confidence in the medical profession. This puts Dr. Kerr in direct conflict once again with Paragraph 65 of the Duties of a Doctor, stating ‘You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the medical profession’. As a result of the ill-prescribed NSAID medication, this caused further experiences of pain for the patient Jane, making her feel nauseous etc. This will have made Jane question the competence of Dr. Kerr and her associated multidisciplinary A&E healthcare team. If she divulges this to other people, it may prevent Jane and anyone she tells from seeking medical help from this A&E department in future cases. In addition, Dr Kerr’s dismissed an automatic alert on the computer system. This would further be lowering Jane’s trust in the medical profession as she is directly ignoring a system specifically put in place to protect patients from any further harm. On Jane’s following visit to the fracture clinic, Dr Kerr failed to approach Jane in order to apologise for her mistake and any further physical or psychological harm she might have caused. If Dr. Kerr had of apologised, Jane might think that Dr. Kerr has realised she has made a mistake, is sorry about it and acknowledges that she could have done better. She could even discuss any further potential action regarding Jane’s treatment plan. This may have made Jane feel more involved in her own medical treatment. The lack of an apology and explanation means that Dr. Kerr again failed to follow the GMC guidelines about openness and honesty. Paragraph 61 states, ‘You must respond promptly, fully and honestly to complaints and apologise when appropriate’. However, due to the actions and professionalism that Dr Dee showed in the GP surgery (by listening carefully, performing a thorough examination and scheduling the appropriate course of action in her treatment plan via an X-ray) are all ways in which Jane’s views of the healthcare profession have hopefully become restored. Jane hopefully will not view the all healthcare professionals as incompetent or unempathetic. Dr. Dee ensured that the patient was made a priority rather than staying to a particular quota. This enlightening GP experience has therefore allowed Jane to successfully continue with an appropriative treatment plan, and so is this experience was incredibly more positive than when she attended A&E.
    2 – As a whole, it wouldn’t be considered irregular that Jane may be feeling undervalued, upset and frustrated with her treatment and the amount of care and empathy and interest that was placed into her particular case. The mistakes and shortcomings clearly made by Dr. Kerr in the A&E department will have obviously left Jane feeling upset and angry with the hospital’s treatment towards her. However, this has indirectly led to other reasons which have further exacerbated Jane’s unhappiness. By prescribing a course of NSAID medicament for Jane, who has a previous history of stomach ulcers, which is an indication against NSAID use, this has clearly had further impacts on her quality of day-to-day life. Consumption of the NSAIDs have caused a greater period of pain and suffering for Jane which could have been so easily avoided. The induction of further pain did nothing to alleviate Jane’s original condition which caused her to attend hospital in the 1st place. This lack of care in an A&E department may be a contributor to a greater issue which may have negative national implications. If more cases like this occur, which is not uncommon in a busy A&E department, patients may feel it is more worth their while to wait for a GP appointment. This will result in the waiting lists and times and many GP surgeries to increase. This is something that is already a crisis for the NHS. There is also the likely possibility that there would be a greater number of missed appointments which can cause further financial problems for the NHS.

    3 – The breaches to patient safety could have been avoided if Dr. Kerr had listened more intently to Jane’s concerns and problems that she described upon her initial visit to A&E. Dr Kerr should have also not have disregarded the systematic alerts set off by the computer system during the consultation. A more detailed communicative medical history of Jane, where the key information about Jane’s stomach ulcer history, would certainly lower the possibility of such mistakes being made.

  30. Anonymous says:

    Dr Kerr’s inability to apologise for the mistakes she made is a very good example of incorrect doctor’s practice. It, to an extent, demonstrates a complete lack of empathy, and a discernment to the rule of making the patient’s safety and health a doctor’s primary concern. Situations such as these put a strain ob the patient’s belief in the doctor’s profession, and the trust Jane may have initially had for medical professionals. This is damaging in future situations in which the doctor’s respectable reputation is essential in achieving a positive outcome in response to an employed treatment. Medical professionals make mistakes, and this is common knowledge, however, every form of medical misconduct can be averted in the future, and should be investigated. I mean, how would you feel knowing you are being treated by a doctor/nurse, who you know is purposefully ignoring you, because of a fear of backlash after committing a mistake? You would probably doubt their competency, and the confidence that is implicated in their actions.

    This inadequate treatment is probably the primary reason why Jane is feeling down, in addition to the undesired outcome of the steps taken in an attempt to alleviate her pain and reduce the impact of her injury on her life. Dr Kerr’s take-home from this situation is to be more careful and considerate when receiving notifications concerning patient data. Also, as a way of improving her practice, Dr Kerr should consider enhancing the quality of the direct care she provides for, and the contact she makes with, patients, which, as demonstrated by her treatment of Jane, is currently inappropriate.

  31. Anonymous says:

    The first doctor’s approach to Jane was very dismissive. She conducted a very brief examination, did not listen to Jane’s concerns and this eventually led to a misdiagnosis, an unsuitable prescription and further pain in Jane’s life. This is stated to make Jane feel upset, and as a result it is likely that Jane has been left with a mistrust towards the profession. Jane’s GP was the complete opposite of this in terms of patient conduct. Dr. Dee listened carefully to Jane’s worries and as a result was able to correct the misdiagnosis Jane received from A&E. This highlights the importance of good patient conduct in consultations.

    Jane’s mistreatment and the lack of respect shown to her is likely to contribute to her sadness over the situation. Her fears were ignored, and later proved to be correct, and so the further pain and illness suffered may be seen as unnecessary and avoidable by Jane. The prospect of increased recovery time is also likely to upset her. As stated she really enjoyed running and this injury and subsequent misdiagnosis is likely to increase the length of time she isn’t able to run for.

    Patient safety breaches can always be avoided by a thorough consultation as the problem is presented. A proper consultation including a proper dialogue on the presenting complaint, medical history, drug history and social history, alongside a through examination of the injury would’ve meant that the misdiagnosis and wrong prescription couldve been avoided.

  32. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession

    Dr Kerr – Through rushing through the diagnosis, treatment and not treating Jane effectively Jane had to suffer for a prolonged amount of time. Upon finding this out Janes opinion of the medical profession would have been damaged. In contrast Dr Dee listening carefully to Janes concerns, looked properly at her medical notes and made sure she promptly made referrals to secondary care to ensure Jane got the treatment she should have previously received sooner. This would have partly restored Janes opinion of the medical profession although subsequently may lead Jane to feel some doctors and better than others.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?

    If Dr Kerr had acknowledged and owned their mistake and apologised to Jane for it this would have gone some way to improving Janes opinion of the medical profession.

    3. Suggest how the Patient Safety breaches in the case could have been avoided

    Dr Kerr should have taken the time to do a full examination of Jane and listened to how Jane was feeling and acknowledged her opinions of her health. This would have helped highlight the severity of the initial accident. They also shouldn’t have ignored the drug alert as in Janes case there was an important reason not to prescribe NSAIDs. This may also highlight an error with the system if some doctors are getting into the habit of skipping drug alerts due to being busy.

  33. Anonymous says:

    1. Dr. Kerr rushes through the consultation and listens briefly due to the time-pressure faced in the A&E department. She does not pay attention to Jane’s concern that the pain she is feeling is different than the usual sprains she has felt before and that she feels it must be more important. She also does not pay particular attention to the drug alert set off by the computer system during the consultation and she prescribes Jane the wrong medication, that ends up leading to stomach pain due to her history of ulcer disease. Dr. Kerr misdiagnoses Jane with a sprain and overall gives Jane a negative view of healthcare.
    Dr. Dee on the other hand listens very carefully to Jane’s concerns despite being busy. Dr. Dee pays particular attention to Jane’s description of her pain and gives Jane solutions by changing her medication that was aggravating her ulcer disease and booking an X-ray which overall leads to a correct diagnosis. Overall, Dr. Dee takes good care of Jane, and leaves Jane with a positive view of healthcare.

    2. The fact that errors were made that were preventable is one of the main reasons why Jane is upset about the whole situation. She must be very frustrated that her concerns were dismissed and how she was not taken seriously. She must also be very upset because she suffered a lot of unnecessary pain by being prescribed the wrong medication that aggravated her ulcer disease and her foot becoming worse and worse. These errors affected her daily life as apart from being in pain, she has also been struggling to move around the house, especially going up and down the stairs. She is also upset because this negative experience, along with the fact that she received no apology has affected her trust in the profession. She must also be upset about how long the diagnosis took and how she had to see two different doctors. She must have been stressed during the process as well, because she did not know what was happening and whether she was going to be healthy in the end.

    3. The Patient Safety breaches could have been avoided if the doctor had listened to Jane’s concerns from the very beginning and payed attention to the drug alerts set off by the computer system during the consultation. Perhaps doing a quick history in the beginning to find out key information about the patient, such as ulcer disease etc. would perhaps also lower the possibility of such mistakes being made.

  34. Anonymous says:

    1. Dr Dee performs a thorough examination whilst Dr Kerr performed a quick examination. Dr Dee listens carefully whilst Dr Kerr only listened briefly. When Jane explains how the pain in her ankle is much worse than any sprain, Dr Kerr dismisses her whereas Dr Dee pays special attention to this concern. As a result, Dr Kerr misdiagnosed with a sprain Jane whereas Dr Dee arranges an x-ray and as a result Jane is correctly diagnosed with a fracture. Jane had two very different experiences and as a result may have conflicting views of healthcare. Dr Kerr negatively impacted Jane’s view on the medical profession and this experience may have damaged her trust in doctors making her less likely to confide to them in the future. However, Dr Dee may have restored some of this trust.
    2. Jane is likely to be upset that the errors made were preventable. For example, initially she explained to Dr Kerr that she thought the ankle injury was much worse than a sprain, yet her concerns were dismissed. If Dr Kerr had listened, an x-ray may have been performed 11 days earlier and she would have received the correct treatment. Also, when Dr Kerr saw her in hospital, she ignored her and didn’t acknowledge that any errors were made or take any responsibility for them. Jane may be upset that she didn’t receive any explanation or apology.
    3. Patient safety breaches could have been avoided if Dr Kerr had not rushed the consultation meaning a detailed and thorough examination would have been conducted and that she would have listened properly to Jane’s concerns. The contraindication alerts are there to protect patients. If Dr Kerr hadn’t ignore these and paid attention to them then she would be aware that the medication prescribed wasn’t suitable for Jane due to her ulcer disease and a breach of patient safety would have been avoided.

  35. Anonymous says:

    1.
    Jane’s experience with Dr Kerr and Dr Dee differed massively. The initial issue with Dr Kerr was she was rushed due to the stressful work environment of the A&E department. As a result, she failed to listen to Jane’s concerns, nor did she take sufficient time to check Jane’s medical history or allergy to medication. In treating Jane with such haste, she neglected to provide an appropriate level of care. Jane would have left the consultation feeling not only dissatisfied but overlooked and somewhat of a burden.
    This, coupled with her misdiagnosis, would drastically reduce Jane’s confidence in the medical profession. The misdiagnosis meant Jane remained in a state of pain for much longer than necessary. On top of this, the incorrect prescription of NSAID medication exacerbated her condition. Through Jane’s (and the majority of the general public’s) eyes, the main role of a doctor is to treat ailments. Dr Kerr’s failure to do this, and instead worsening Jane’s condition, would make Jane question the capability of healthcare staff and possibly prevent her from seeking help in the future. Whilst doctors cannot be-nor are expected to be-correct 100% of the time, Jane’s misdiagnosis may cause her to question the training and education of doctors. The refusal to x-ray, despite Jane’s insistence that this was more than a sprain, makes the misdiagnosis less acceptable as steps could’ve been taken to confirm Dr Kerr’s original assumptions.
    Furthermore, Dr Kerr’s dismissal of the automatic alert system would be another factor in lowering Jane’s trust. This system in in place to protect patients, so by ignoring it, it would appear Dr Kerr has no interest in doing so. It gives the impression she values her own opinion above technology.
    Upon Jane’s return to hospital, Dr Kerr noticed Jane but failed to approach her to apologise for her mistake. An apology would show Jane Dr Kerr was aware of her error and put her at ease that it would be unlikely to happen to her, or other patients, again. Jane would have felt acknowledged and more involved in her own healthcare. Generally, patients will understand that mistakes happen, but the lack of an apology and explanation can cause more damage. Dr Kerr failed to follow the GMC guidelines about openness and honesty. She did apologise for the harm or distress that came to Jane, nor did she explain what happened and the effects it may cause.
    Dr Dee’s exemplary actions hopefully restored Jane’s views of the healthcare profession by seeing not all healthcare staff will conduct their practice as Dr Kerr did. Jane was made a priority. She was scheduled in for a morning appointment despite the surgery being already busy. Dr Dee was already familiar with Jane, so trust was established, but still made an effort to build a good rapport to maintain the essential patient-doctor bond. It is unclear as to if Dr Dee was able to make the diagnosis of a fracture, but, having considered her history and concerns, the appropriate decision to x-ray was made. Dr Dee’s awareness of Jane’s previous stomach ulcers meant she could receive proper pain relief. Her GP experience resulted in her being able to progress with treatment, so is overwhelmingly more positive than that in A&E.

    2.
    Jane should be feeling let down and upset with her treatment. The errors, of course, would be a key factor but the issue is deeper than this. Jane’s worsening condition has impacted her daily life. This prolonged suffering could have been avoided had her initial concerns not been dismissed. Not only did her original disorder not improve, the NSAID medication produced an entirely new complaint.
    Jane would be upset with Dr Kerr’s actions upon seeing her again. No apology was offered and as a result Jane was made to feel insignificant. The patient should always come first, but Dr Kerr put her pride first in not approaching Jane to admit her mistake. Doctor’s have a duty to acknowledge and apologise for mistakes when appropriate-and this situation was indeed appropriate.
    Her A&E visit was ultimately a waste of time and appropriate medical care was delayed. The dismissive manner with which she was treated meant she left feeling low and not achieving what she came in for. Jane waited for several hours with her daughter in A&E. Within the same space of time, she visited the GP, had an x-ray, and got the results back. She probably felt frustrated that she waited the same length of time in A&E to no avail, when she could have had the issue dealt with the same day if she went to her GP first. This may cause a wider issue. If more cases like this occur, people may be more inclined to wait for a GP appointment which will only cause the waiting times in GP surgeries to increase, or appointment slot times to decrease.

    3.
    Firstly, the patient safety breaches could’ve been avoided if Jane was properly listened to in the first place. Often the patient knows their body best and is an invaluable source when making diagnoses. Doctor’s should be made more aware of this and trained to consider the patient’s opinion alongside their own.
    The warning screen should for drug intolerances should not have been ignored. It is understandable that doctors want to complete a consultation quickly to cope with the volume of people but overlooking something like this can be fatal and it should not be assumed that all patients will have the same reactions. Perhaps a different system, with different warnings indicating the severity of the patient’s reaction could be implemented.
    A patient’s history, even brief, is crucial in delivering an accurate diagnosis. Jane’s safety would not have been put at risk if the doctor was made aware of her Type 1 Diabetes and stomach Ulcer history in person, rather than from a computer system. On a larger scale, more funding and staffing is needed to reduce the stress of hospital departments and thus, allowing for more thorough consultations.

  36. Anonymous says:

    1) The two doctors have differing views and offer different treatments. Dr Kerr did not conduct a detailed examination, and as a result did not diagnose a fracture. Dr Kerr was also dismissive and was impersonal in approach and as a result Jane may feel dismissed and may not feel as easy to discuss health issues as readily in future. The GP on the other hand was personal and performed a more thorough examination.

    2) A mistake was made by Dr Kerr by not performing a thorough examination and history of Jane and also missed an opportunity for an appropriate apology. Jane may be distressed and frustrated by both of these factors and may lose trust in the profession.

    3) Dr Kerr could have avoided putting patient safety at risk by performing a thorough examination and history of Jane and recognising the need for composure and due diligence in acknowledging Jane’s complaint of her pain. Dr Kerr should have also recognised the medication warning and acted appropriately.

  37. Anonymous says:

    1.Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    The initial dimissive behaviour will make Jane feel less likely to speak up on what she feels is important for her health in the future or to trust further medica professionals. However, the second contact with her GP and the Orthopedic doctor has encouraged her that they take the issue seriously and listen to her concerns.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    The error has led to uncecessary uncomfort and impacted her everyday activities which would make you upset. This will also have an impact upon her recovery time as well.

    3. Suggest how the Patient Safety breaches in the case could have been avoided

    Staff should have enough time to go over everything accurately, not checking the pain medication alert has also been detrimental so perhaps a more varied alert system to highlight more extreme issues more effectivey could be implamented

  38. Anonymous says:

    1.Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    The A&E doctor that Jane saw was in her eyes dismissive of her. She is likely to lose trust in the medical profession by this. Whereas her family doctor did take her concerns into consideration and started resolving the issue confirming janes suspicions. this may elevate some of her dissatisfaction and mistrust.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Jane is upset because of how she was treated and how her input was dismissed by the doctor. However, would not have been nearly as upset if the A&E doctor was correct. her dissatisfaction is compounded by the way she was treated and the misdiagnoses. Furthermore, the mistake of prescribing counter indicative medication is something that may have greatly increased her dissatisfaction.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    If Dr.Kerr did not dismiss the warning and take the time to prescribe a suitable analgesic. Updating the system so that it is reliable is also important as this is likely not the first nor the last time this will happen.

  39. Anonymous says:

    1. Dr. Kerr’s actions have not only led her to a worsening condition, but have also damaged the repuation and trust that Jane has with the health system. Dr. Kerr was neglecting important history of the patient, was rushing her out, and failed to apologize for their mistake. On the other hand, her GP took time to listen and care for Jane, and offered very different advice and treatment for her than Dr. Kerr. He took a few extra minutes to hear and listen to her complaints, and communicated effectively with Jane to determine further steps.

    2. Jane likely felt that her concerns and pain were not heard, and that she was personally ignored. Moreover, she noticed Dr. Kerr avoiding her, which only made her feel less acknowledged and that the care provided from the hospital was not sufficient.

    3. The doctors should take automatic alerts seriously and should always be considered or acknowledged before prescribing drugs. Better communication with patients should also be practiced. Lastly, doctors should be more attentive and provide a more thorough examination.

  40. Anonymous says:

    1. The initial doctor, Dr Kerr and the subsequent A and E Doctor’s actions contradict each other and so this may mean that Jane’s trust in the profession lessens. Dr Kerr’s initial assessment was rushed and incomplete and so Jane might feel ignored and the fact that Dr Kerr did not listen to her may have been seen as patronising and condescending towards Jane. Also, the failure of Dr Kerr to apologise may leave Jane feeling possibly angered and frustrated because she knows an error has been made in her care.
    2. The errors are certainly cause enough to make Jane upset but she may have also been saddened by the fact her concerns were dismissed, her care was not centred around her and the fact that the ignorance caused more harm by letting the injury go on further without the correct treatment and the prescribed NSAIDs angered her stomach ulcers. Also, the lack of an apology from Dr Kerr after the pain that Jane has suffered could certainly upset her as she deserves an apology for her lack of care.
    3. Patient Safety Breaches could have been avoided if Dr Kerr had been more thorough in taking a history especially regarding the stomach ulcers. Also, if Dr Kerr had better communicated with Jane ensuring she felt listened to and respected.

  41. Anonymous says:

    Primarily, each physician owed it Jane, as their patient, to listen to her. It is only natural that Jane should feel let down by the treatment she received from Dr Kerr at their first contact as not were her concerns dismissed, she was misdiagnosed and prescribed medication that was harmful. In contrast, Dr Dee took the time required to listen and investigate adequately. Moreover, despite also being busy, Dr Dee made the appropriate referral to the X-ray department and escalated Jane’s care, facilitating the correct diagnosis and management. This degree of professionalism is what Jane expected when she sought medical attention on both occasions and thus may go someway in restoring her trust in the profession.

    The fact that errors were made in her care are certainly reasons for Jane to be upset, however the manor in which she was treated during her first consultation and the complacency with which she was regard may ultimately be the most disappointing thing to her. Jane sought medical attention and expected to be treated with respect, to be listened to and for her concerns valued.

    The patient safety breaches in this case may ultimately have been avoided if Jane and her concerns had been truly valued. By not fully examining Jane’s injury, listening to her concerns or reading her medical records, Dr Kerr showed complacency that ultimately resulted in harm. Unfortunately, by not taking ownership of her actions once she was made aware of them, instead choosing to ignore Jane on her second presentation to the department, Dr Kerr’s behaviour suggests that perhaps she has not yet fully learnt from these mistakes.

  42. Anonymous says:

    1.
    Dr Kerr’s interaction with Jane was quick, came after a long wait and resulted in an incorrect diagnosis, despite Jane’s explicit concerns that what she is experiencing is more than a sprain. The long wait for a quick assessment would make Jane frustrated, but would of been acceptable if the correct diagnosis had been made. Dr Kerr failed to listen to the patient, and made a mistake because of it. Additionally, Dr Kerr made a further error by prescribing a drug that adversely reacts with Jane, causing her to go through unneeded pain. This has likely reduced the trust Jane puts in the medical profession. On the other hand, Dr Dee did everything right. By listening to the patient the Dr made them feel at the centre of their healthcare. By making the correct diagnosis the future looks well for Jane as she at least knows what’s wrong with her. This has likely given Jane more trust in the medical profession.
    2.
    Not just that errors were made, but why they were made. Dr Kerr’s lack of attention to the patient and what they had to say does not represent how the public would like their Doctor’s to act. Jane was made not to feel at the centre of her healthcare. The dismissive attitude of Dr Kerr by ignoring what Jane had to say make Jane feel, understandably so, upset.

    3.
    Dr Kerr being rushed made her ignore the concerns in front of her, both from the patient and the computer screen. Dr Kerr should of taken her time in order to make the correct clinical decisions, and in doing so keep the patient safe.

  43. Anonymous says:

    Due to A&E being busy, the original doctor who performed the first examination misdiagnosed the presenting complaint whilst also ignoring Jane’s concerns. This could lead to a lack of trust between Jane and the healthcare system meaning it could result in Jane being unwilling to attend future appointments in the fear that she won’t be listened to. The GP however took a more caring approach listening to Jane’s concerns and respecting them, by allowing Jane to have an X-ray and discontinue to prescribed medicine.
    Errors are not the only factor contributing to Jane’s upset, the fact that Jane was ignored could mean she feels a lack of respect.
    Breaches in patient safety could have been avoided with a more thorough original examination and not ignoring notifications regarding the medicine prescribed.

  44. Anonymous says:

    1. The behaviour of both doctors was very different. The A&E doctor did not respect Jane and ignored her concerns, which may impact Jane’s willingness to go back to the hospital in future and cause her to lose trust in the doctors treating her there. However, Jane’s GP had a very empathetic approach and listened to Jane thoroughly and genuinely helped her by stopping the medication that was making her feel unwell and sending her back to A&E. I feel that this experience may have improved Jane’s perception of the health care system slightly, although her initial encounter with the A&E doctor might leave her feeling unsure and confused.
    2. A s well as the errors made I feel Jane would have been upset as her concerns were ignored before leaving A&E initially and on returning she was not even addressed by the same doctor.
    3. The patient safety breaches could have been avoided if the initial consultation hadn’t been so rushed so that the patient history could have been read more thoroughly and the alert on the system not been ignored. Therefore Jane would not have been given NSAID and her fracture might not have been overlooked.

  45. Anonymous says:

    1. The two doctors behaviours are very different so Jane may feel conflicted and less trusting of the medical profession. She may decide to not go back to hospital if she is unwell again due to this mistrust of the profession and that the hospital care isn’t good enough.
    2. The doctor did not respect Jane’s opinions and concerns about her pain, they instead dismissed her.
    3. Dr Kerr was too quick to diagnose a sprain due to the pressure she was under, and an unsuitable medication was prescribed as there wasn’t careful checking of Jane’s history. These errors have led to patient safety breaches causing unnecessary suffering.

  46. Anonymous says:

    The behaviour of Dr Kerr could cause Jane to lose trust and confidence in the medical profession as a result of the care she received. Due to her performing the examination in haste, Dr Kerr failed to identify Jane’s fracture and dismissed the contraindication alert without taking the time to assess potential consequences. Moreover, later, when Dr Kerr identifies her errors, she fails to convey this to Jane and apologise for her mistakes. This will impact trust because as humans everyone makes mistakes, so this concept, while it can be particularly unpleasant in the health setting, is not foreign to patients. However, failing to apologise in light of errors will promote distrust due to the integrity of the profession not being upheld.
    On the other hand, Dr Dee, despite working under the busy schedule within the GP surgery ‘listens carefully’ to Jane and performs a thorough examination detecting the signs the A&E doctor overlooked. This leads to Jane’s fracture being identified, the stopping of the NSAID medication and further steps being taken for assessment of her fracture. Jane feels like she is heard, and the doctor seeing her cares about her wellbeing and is not dismissing her concerns. This promotes trust of the medical profession as the GP is conscientiousness and doing all they can to help Jane by laying out progressive actions to treat her condition.

    Jane’s unhappiness with this situation is a combination of things. Not only did she feel dismissed by her A&E doctor, but mistakes were also made causing her unnecessary pain. After seeing her GP who correctly identifies Jane’s problems, she perhaps realises the initial errors could have been avoided and could be attributed to carelessness. Furthermore, when Jane is in A&E for her fracture assessment, Dr Kerr fails to apologise for her errors upsetting Jane further because it conveys the doctor doesn’t care about Jane’s wellbeing and doesn’t feel remorse for the unnecessary pain Jane went through. Although the mistakes were what initially upset Jane, the fact Dr Kerr failed to apologise keeps Jane feeling this way.

    Patient Safety breaches could have been avoided if despite the busy environment, Dr Kerr had thoroughly assessed Jane and reviewed the contraindication alert before dismissing it. She would have identified Jane’s fracture and not given her medication that her body would respond adversely to. Her fracture assessment would have taken place sooner, and Jane’s recovery would be close to, if not already underway. Dr Kerr’s lack of apology could result in Jane being hesitant to listen to health professionals in the future which could result in further Patient Safety breaches due to a lack of trust in the Health Service.

  47. Anonymous says:

    1. Jane’s trust of the medical profession was negatively affected by her experience with Dr Kerr, while Dr Dee was able to correct the mistakes in her treatment and somewhat restored Jane’s faith in health care professionals. Dr Dee seemed more interested in what Jane herself had to say, instead of just purely relying on existing notes or guidelines of diagnosis. She did not ignore Jane’s concerns and was more inclined to trust the patient and not have her opinion swayed by the previous diagnosis. If the two doctors are compared, Dr Kerr was talking to Jane as her inferior and not equal, while Dr Dee worked together with Jane to try to get a better understanding of the accident and previous medical history. Dr Kerr made Jane feel like a burden and only a part of her busy work routine, but Dr Dee’s practice was able to arrange an emergency appointment and validated Jane’s experience.

    2. Jane feels upset not only because there were errors made in her diagnosis, but also because she had concerns about the severity of the injury but they were dismissed by the A&E doctor. Thus, Jane felt like her feelings were not taken into consideration and she was not listened to. To add, Jane was ignored by Dr Kerr in her second visit to the A&E, so she might feel like the doctor does not have Jane’s best interests at heart and that Dr Kerr does not remember her, further harming the patient-doctor bond. Jane was put through a lot of pain and ultimately her condition worsened, which could have been easily avoided. She was not able to be physically active and lost her appetite, so she must feel like she experienced more harm than help.

    3. Breaches in patient safety could have been avoided by Dr Kerr taking a better patient history and being more attentive towards Jane’s concerns. Larger scale changes would be needed to increase patient safety and decrease the pressure put on doctors, for example, decreasing the workload of A&E doctors to allow for more thorough consultation, and potentially increasing the funding/reducing the criteria to be satisfied for examinations. The drug alert suggested the patient might not be compatible with the chosen medication. Despite the system usually being oversensitive, the alert should have been taken into consideration and patient’s notes should have been consulted to find out which drugs the patient is allergic to or identify previous illnesses which might be aggravated by certain drugs.

  48. Anonymous says:

    1. The doctor in A&E was very rushed and did not take time to examine Jane properly. She also didn’t listen to Jane’s concern that this pain felt different to sprain injuries she had experienced in the past. She also decided to ignore Jane’s allergy to this medication and caused her further harm. This would tarnish the image Jane has of the NHS. However, Jane’s GP was very attentive and took time to listen to her and examine her properly despite being busy. The GP also knew her about her ulcer and put her off the medication and gave her other pain relief. This may have helped regain some confidence in the NHS.
    2. I think Jane was mostly upset by the effect these errors had and the fact she had been in a lot of pain for 10 days. She was probably very upset as well because the doctor in A&E refused her request for an X-ray and didn’t listen to her concerns. The lack of apology from the doctor possibly also upset Jane.
    3. The breaches could have been avoided if the A&E doctor had taken the time to examine and listen to Jane thoroughly. The doctor should also have looked more closely at Jane’s allergy and medical history as not doing so resulted in further pain for the patient.

  49. Anonymous says:

    1. The behaviour of the two doctors was very different. Dr Kerr, in A&E, was rushed, did not take much time to listen to Jane and lacked empathy and patience. While her interpersonal skills were not very good, she also neglected the medical side by ignoring Jane’s allergy to a certain medication she prescribes and rushes the examination. As discussed in Story 1, Jane will have felt neglected and was left with a lack of trust. Dr Dee, Jane’s GP, gave Jane a very contradictory experience. Although busy, Dr Dee takes time to listen to Jane, has good interpersonal skills and shows that they know their patient well by taking her off the medication she is allergic too. This contrasting experience may reinstate Jane’s trust and improve her opinion of doctors. She also will have left feeling heard and cared for.
    2. Dr Kerr’s mistakes left Jane in a lot more pain, other parts of her health have been affected by the medication and she now needs an operation. Although this would not be the only reason to upset Jane. The way Dr Kerr treated Jane – rushing the examination and not communicing well would be upsetting. The fact that Jane knew there was something else wrong but was not taken seriously would add to the frustration. For these reasons it would be important that Dr Kerr apologised and acknowledged the mistakes.
    3. To avoid breach of patient safety, from the outset, Dr Kerr should have taken time to examine Jane properly, talked to her more clearly to find out if there was anything Jane felt out of the ordinary and listened to Jane’s comments. The contraindication alert on the medication should also not have been ignored. Taking these factors into consideration, Jane’s safety could have been a lot more protected.

  50. Anonymous says:

    1. The behaviour of the two doctors are very different and therefore may give Jane contradicting views of the medical profession. Jane may have lost trust in the medical profession after her visit with the A&E who was busy and may have rushed her. But following the visit by her GP who has known Jane for a longer time frame, she may have had her faith restored as the GP was able to spot the mistakes made by the previous doctor and fix them. Janes view of the medical profession may be based on location. She may view doctors working in hospitals as incompetent and see GP doctors as more reliable.

    2. I fell like it was because errors were made, as well as other reasons that Jane was so upset. Jane may feel upset that the errors that were made were preventable if the A&E doctor had listened to her and spent a bit more time with her. Jane may be upset that the issue was not addressed when she felt came into the hospital and maybe annoyed that she now has to come back in again. Jane may also be upset that she is still in pain to the point at which it is affecting her daily life e.g as she is unable to go up and down her stairs.

    3. Patient Safety breaches in the case could have been avoided if Dr Kerr was not busy during the visit with Jane and had time to actually listen to Jane, therefore the breach in communication between doctor and patient played a big role in the breach in patient safety. Another patient safety breach occurred when the doctor ignored the warning given by the system to not prescribe Jane NSAID, and although the doctor was aware of Jane’s previous history with stomach ulcers, she still gains Jane NSAID. I also felt a breach to patient safety was made when Dr Kerr chooses not to apologise to Jane for missing key information and delaying Janes diagnosis. This highlights the doctor’s lack of empathy and unwillingness to take responsibility for her action – an undesirable quality for a doctor.

  51. Anonymous says:

    1. The behaviour of the two doctors is quite different. Jane may struggle to know who to trust now after this incident as she has been told very different things. She may be less likely to attend the hospital or GP surgery again if something is wrong as the profession has let her down before.

    2. I believe Jane may also be annoyed at the rushed approach adopted by the doctor in A&E as she treated her in a hurried fashion and didn’t take the time to ensure she was treated with dignity and respect. It was quite an impersonal interaction and it was obvious to Jane that the doctor didn’t have a lot of time for her.

    3. The Patient safety breaches could have been avoided by not rushing through the initial consultation and taking time to thoroughly examine the patient. Also, ensuring that medical history is taken from the patient in an accurate manner, allowing their voice to be heard and valued and concerns to be taken into account.

  52. Anonymous says:

    1. The behaviour of the emergency doctor could negatively affect Jane’s trust of the medical profession, as not only did the doctor mistreat her at first, not taking her views and feelings into account, this leading to a wrong diagnosis and a lot of further pain, but also they did not apologise for their mistake when they met Jane for the second time, displaying a very untrustworthy attitude. On the other hand, the GP’s behaviour could increase Jane’s trust in the medical profession, as they showed a very professional and serious attitude, listening carefully to the patient’s story, concerns and fears.
    2. Other things that might affect Jane could be the fact that, for a long period, she won’t be able to run, with running being one of her favourite activities. Also, the pain she had been through, coming from both her ankle and her stomach might be another upsetting factor.
    3. Firstly, I believe that, if there had been more doctors in the Emergency Department, the doctor that took care of jane wouldn’t have been tired and tempted to just quickly evaluate the patient, without taking care of their concerns. Therefore, more medical staff could have helped to avoid the situation, together with the prevention of the overcrowding of the Emergency Room. Moreover, if the doctor would have paid more attention to the patient, sticking to the GMC Guidelines, most of the Safety Breaches could have been easily avoided.

  53. Anonymous says:

    1. Dr Dee made Jane feel welcome and listened to. His clinic was able to fit Jane in in a busy clinic and provide a high quality service by taking his time and properly listening to the concerns of the patient. Dr Kerr however, payed less attention during the consultation and quickly rushed through it without listening to Jane’s concerns. What’s more, Dr Kerr’s lack of attention when the computer system brought up a contradiction alert brought Jane more pain and could’ve potentially been life threatening. Dr Kerr’s actions may cause Jane to lose faith in the medical profession where as Dr Dee’s actions may cause Jane to put more trust into it.
    2. Jane is also greatly upset due to the large amount of pain she is feeling. Dr Kerr can be seen avoiding her in the hospital, and so the lack of responsibility taking and lack of apology also have aggravated her.
    3. They could’ve been avoided through listening to the patient from the beginning and by taking the contradiction on the computer system seriously.

  54. Anonymous says:

    The two doctors described – Dr Kerr and Dr Dee – acted very differently regarding their approach to Jane’s concerns. While Dr Kerr did not seem willing to take the patient’s perspective into account, Dr Dee listened to Jane and was therefore able to deal with her case in an appropriate way.
    Being listened to and feeling that your concerns are treated seriously is extremely important from a patient’s point of view. When the opposite is happening, it is possible that patients loose their trust of the medical profession. Therefore, Dr Kerr influenced Jane’s view most probably in a negative way while Dr Dee was perhaps even able to restore some trust due to her actions.

    Mistakes happen, unfortunately. The way you react if something goes wrong is crucial. Jane is probably quite upset, that the doctor that made the mistake does not seem (at least from her point of view) willing to apologize and to make sure that something like that will not happen again.

    Actively listening to patients is extremely important. The fact that Jane is a veteran runner as well as the information that she had never experienced pain like this before, could have helped the A&E doctor to assess her case correctly. Additionally, the prescription of a drug which could have a very negative impact on a patient’s health could be prevented by taking a good medical history (Are you allergic to any drugs? Is there anything to take into consideration?…) and by not neglecting the computer alert which was created to prevent something like that happening.

  55. Anonymous says:

    1. A patient’s trust in the medical profession is vitally important for effective healthcare practice.
    Dr Kerr did not assess Jane effectively and hastily dismissed her concerns, leading to errors in Jane’s care. In addition after realising her mistakes Dr Kerr did not take responsibility for her actions and apologise to Jane, breaching article 55 of Domain 4: Maintaining Trust in the GMC document Good Medical Practice. This experience may have left Jane feeling disrespected and unheard which could diminish her trust in the medical profession – especially secondary care. However, Dr Dee acted in a professional and empathetic manner, listening carefully to Jane, performing a thorough examination and referring her to a local hospital for an x-ray where the correct diagnosis was reached. Dr Dee also consulted Jane’s medical records to amend the prescription causing stomach pain, an additional complication caused by Dr Kerr. The actions of Dr Dee may have rebuilt Jane’s trust in the healthcare profession but this may be isolated to primary care, Jane’s experience may still cause her to negatively view secondary care.

    2. The emotions Jane is experiencing are due to the wider implications of the clinical and professional errors made. Jane was made to suffer for an additional 11 days before the correct treatment was offered, resulting in deterioration of her health. Jane describes the pain as the worst she has ever felt, her mobility was compromised and due to the medication prescribed she was left nauseous and worried – a substantial impact on her social and psychological wellbeing. In addition the lack of recognition from Dr Kerr would most likely leave Jane feeling that Dr Kerr doesn’t care about the errors made. This could result in Jane losing confidence in the medical profession and cause fear regarding returning for further treatment in case more mistakes are made.

    3. Although Dr Kerr was feeling stressed and under pressure, this should never compromise patient safety. Dr Kerr should have conducted a thorough examination of Jane, gathering a detailed history. She should also have actively listened to and fully appreciated Jane’s concerns when deciding on a diagnosis and treatment plan. The contraindication alert advising against using NSAIDs should not have been ignored as its purpose is to prevent adverse drug reactions and protect patients from unnecessary harm. Finally Dr Kerr should not have ignored Jane, she should have taken responsibility for her errors, apologised and taken action to ensure this mistake is not made again.

  56. Anonymous says:

    1. Jane has received a significantly different experience from her A&E doctor and her GP. Her lack of recovery and in fact worsening condition has resulted from the lack of sufficient attention from the A&E doctor, who rushed through the examination of her ankle. The fact this doctor dismissed Jane’s concerns must have made her feel unjustified in her pain. This poor example of care will have damaged the trustworthy reputation of the medical profession in Jane’s eyes. On the other hand, her GP was very attentive and made time to see her despite being bogged under with other patients. The GP provided Jane with a full comprehensive consultation, in which she listened to Jane’s full account of the story and the devised a new plan of action for Jane, fixing the errors made by the secondary care physician in A&E. This more positive experience may have aided Jane to re-develop trust in the medical profession
    2. Jane seems to be upset as a result of the combination of her deteriorating condition and lack of recovery and the fact that she was made to feel unimportant by the A&E doctor when she did not address her concerns in an appropriate manner. I would certainly believe this is a justified way to feel given the circumstances.
    3. If a full examination had been carried out with a full medical history taken and with the patient’s concerns taken into account then these errors could have been avoided. Doctors and pharmacists should always read the contraindication alerts as well as any interactions with other medications the patient is taking as to avoid harmful effects.

  57. Anonymous says:

    Dr Dee, the family GP, appears to show Jane more compassion and affords her more time during the consultation, ultimately resulting in a more accurate diagnosis than Jane received in A&E. This could be due to the trusting relationship already in place between Jane and Dr Dee, which wasn’t the case with the Doctor she saw at A&E. This contrast in approach from the two medical professionals shows a lack of consistency and may make Jane feel as if she cannot trust certain Doctors.

    I believe Jane may also be upset because of how the A&E Doctor ignored her concerns that the injury was more than a sprain. As explained in the text, Jane has suffered sprains before and tried to explain to the Doctor that this injury was much more severe. These opinions being ignored may have made Jane feel as if she was being looked down upon. In addition, the errors in the initial diagnosis resulted in Jane spending around 10 days in poor health, unable to move freely around her own home.

    If the initial examination had been carried out with more focus and care, these errors could have been avoided. External factors such as stress were likely to be impacting the A&E Doctor at the time which resulted in the misdiagnosis however, likely due to the large number of patients in the waiting room and constant pressure that results.

  58. Anonymous says:

    1. The behaviours of the two doctors are very different. Dr Dee (The family GP) is the perfect example of how a medical professional should behave with a patient, listening to Jane’s concerns and to the whole story of how the injury happened and taking into consideration Jane’s past medical history of ulcers and her contraindication of taking NSAID, while Dr Kerr (the A&E doctor) is at the exact opposite of the spectrum, disregarding the system alert regarding the patient’s contraindication for using the particular medication and the patient’s concerns. Even if the A&E department is very busy and the system is issuing warnings for small things, it is better to have a quick read through the warning, just to make sure that there is no possibility of causing the patient any inconvenience or even putting them in danger.
    In this case, even if Jane trusts her family GP and will probably be grateful to him for helping her, the behavior of the A&E doctor would probably make her lose her trust in the profession, as in addition to her initial injury she was also caused a big inconvenience with her stomach, due to the medication she was prescribed. From now on, Jane might not have faith in any medication she will be prescribed and as a result she might not follow future courses of treatment. Also, she might feel betrayed by the profession due to Dr. Kerr’s dismissal of her worry related to the ankle injury, as she was proven to be right and maybe if the issue would have been properly diagnosed from the beginning she wouldn’t have needed surgery and the recovery would have been easier and less stressful. Jane might also feel Dr. Kerr disrespected her, as she undermined Jane’s ability to recognize when something is wrong with her own body.
    2. In my opinion, there are a multitude of factors contributing to Jane being upset. Firstly, and the most obvious cause for this would be the mistakes made related to her care, i.e.: being misdiagnosed in the first place due to the overcrowded A&E department, in addition to the doctor not properly listening to her concerns and being proven that if an X-Ray would have been made in the first place she might not have needed a surgery as the fracture might not have been as bad as it is 11 days later. Being prescribed the wrong medication, which caused Jane additional inconvenience (having an upset stomach), is another contributor to the mistakes made. Also, she is now obliged to take an additional medication to alleviate the symptoms caused by NSAID, which will also upset Jane.
    Secondly, Dr. Kerr’s lack of apology is, in my opinion, a huge contributor to Jane being upset, as it is a further dismissal of her from the doctor’s part. Also, it may seem to Jane that the doctor is ignoring her even further, in addition to the mistakes she made and that she is not willing to face those mistakes. This is a further undermining of the patient and the patient’s trust in the profession. A simple apology could make the patient feel so much better, as the doctor recognizes she was wrong, and after all, being wrong is human. As a doctor there is a duty of recognizing and apologizing for your mistakes.
    3. The Patient Safety breaches in this case could have been avoided in the first place if the A&E doctor would have not thought of the number of patients she has to see in the day of the initial assessment of Jane’s injury. Dr Kerr should have taken her time (without stalling or wasting any valuable time) to properly consult Jane and listen to her worries. After all, the patient knows her body best and even if Dr. Kerr did not think Jane’s opinion was correct, she should have listened to her and take her opinions into consideration and either consult with another consultant or schedule an X-Ray. Also, Dr. Kerr should not have dismissed the warning that the system issued related to Jane’s history of ulcers and if she was not sure about the system being right, she should have consulted Jane and taken a proper history of the patient, in which case her history of ulcers would have probably been disclosed and the stomach problems could have been avoided.
    If we think on a bigger scale, such breaches could be avoided by changing the system. This could be done by not putting so much pressure on the A&E doctors to see as many patients in as little time as possible. Also, the system should be mended in regards to issuing warnings that are not necessarily needed or maybe have a colour code for the most important warnings, so that they will not be ignored by the doctors.

  59. Anonymous says:

    1. Dr Kerr was very adamant that her diagnosis was correct and completely ignored Jane’s concerns. This led to a misdiagnosis and caused Jain a lot of discomfort. This probably caused Jane to be weary of the medical profession, making her feel as though she wasn’t heard and that her problems were insignificant. On the other hand, her GP listened to her concerns carefully, took into consideration what she said as well as her past history. She made Jane feel comfortable and communicated well what the solution to her problem was. She delivered personalized care and empathized with Jane. This probably gained her Jane’s trust and appreciation.
    2. Jane is not only upset due to the errors made, but also because she was made to feel as though her concerns didn’t matter, and that she wasn’t heard. She should have been listened to properly. She also did not receive any kind of recognition or apology from Dr Kerr after the misdiagnosis.
    3. Patient safety breaches could be avoided by communicating better and listening to one another. The first consultation with Dr Kerr was a mishap because she rushed through it and didn’t consider possibilities besides the one she first assumed, and she didn’t pay any heed to Jane’s concerns. This worsened Jane’s situation and caused her to doubt the healthcare system.

  60. Anonymous says:

    1.The behaviour of the first doctor will have tainted the trust in the relationship and the future relationships which Jane shares with her doctors. She feels she wasn’t listened to by the first doctor giving her a negative experience which she may class with the rest of the doctors from now on. A simple apology could have changed Janes feelings about this situation, but with the first doctor ignoring her when seeing her in the hospital, the situation in Janes eyes has not been resolved. The second doctors however (GP) listened to Janes medical history, looked at her notes (advising her not to continue with the medication which upsets her stomach) and provided an alternative medication. Listening to Jane they requested an X-ray which is what she needed from her first consultation in A and E. This would have give Jane a mixed message, one doctor which she doesn’t trust and the other which she does.

    2.I believe Jane is upset at the errors that were made as 11 days after the fracture she is only receiving the operation she should have got 11 days prior (in which days she endured suffering). I also think she feels upset as she may feel that the first doctor undermined her ability to recognise that she may have done serious harm to leg and the way in which she was treated in the consultation (rushed). She may be thinking if they had not of rushed her consultation, they may have got the correct diagnosis and she would have got her operation sooner, enduring less pain. I believe both these reason may upset Jane.

    3. The patient safety breaches in this case could have been avoided if the first doctor did not rush her consultation and had looked at Janes medical notes. This being as she could have found the correct diagnosis and gave Jane an appropriate medication for pain relieve which did not upset her stomach ulcers. Both these actions resulted in Jane condition worsening.

  61. Anonymous says:

    1.The contrasting behaviour of the 2 doctors have brought up trust issues with the doctors for Jane.She might always doubt the treatment provided to her and will always go for a second opinion.
    2.The lack of apology and ignorant attitude from the doctor (Dr.Kerr) has affected her more. Jane would have probably acknowledged that mistakes happen as doctors are humans after all, however, the doctor showing no remorse for the suffering she caused to Jane might have made Jane doubt the sincerity of doctors towards their patients as well as their profession.
    3.Patient safety breaches could have been avoided if the doctor had not ignored the system alert regarding Jane’s prescription. She could have done a quick check on Jane’s drug reaction history which would have avoided the unnecessary pain to Jane.

  62. Anonymous says:

    1. The two doctors acted very differently although they both were in busy conditions. This affects Jane’s trust in the healthcare system as when she comes into contact with any doctor in the future she might not know whether they will take full interest in her matter or whether they are just trying to keep patients flowing in or out. She may be skeptical of any diagnosis in the future. Jane must have felt like she wasn’t listened to or taken seriously as even she could tell that her ankle was more than just a sprain. This may result in Jane not coming to hospital anymore as she might believe that doctors are quite inconsistent.
    2. Errors were certainly made in this situation however a lack of communication between Dr Kerr and Jane is also key. Jane will have felt that she was not listened to or treated like she was inferior to the doctor. Dr Kerr may have appeared to be condescending in saying that Jane’s ankle was ‘just a sprain’. Her opinion was not listened to or taken seriously which is a major error.
    3. Patient safety was breached as Jane’s ankle got worse to the point where she needed surgery, which might not have been necessary if initially diagnosed as a sprain. She was also given medication that made her stomach ulcer condition worse which physically caused her pain and therefore breached patient safety.

  63. Anonymous says:

    3. Suggest how the Patient Safety breaches in the case could have been avoided

    1. Her GP was far more open to Jane’s input and investigated all the symptoms carefully, whereas the hospital doctor was dismissive of her concerns and was evidently distracted throughout the consultation. This provides conflicting perspectives that may cause Jane to be less trusting of those in the medical profession.

    2. Although the errors are a large part of the reason Jane is upset, she is likely also not happy about the fact that her worries were dismissed and she was not listened to.

    3. The patient safety breaches occurred because the doctor at the hospital for the initial consultation was rushed and distracted due to the busy A&E department. Additionally the dismissal of the warning about the NSAID drugs likely caused additional damage to Jane’s body.

  64. Anonymous says:

    1. The A&E doctor’s approach to seeing Jane may have damaged her perception of healthcare as it was a quick and ineffective example of an examination which failed to treat Jane. As a result, Jane’s trust in the healthcare system may be damaged. Moreover, the fact that her symptoms worsened having seen Dr Kerr may further damage this trust as she may feel like the hospital visit has actually made her worse and her initial worries, which were dismissed by Dr Kerr, weren’t addressed. Contrastingly, the visit to her local GP may have made Jane feel like she could still have faith in the healthcare system as Dr Dee listened carefully to Jane’s concerns and his recommendation of an X-Ray allowed Jane to get the surgery she truly needed. The fact that Dr Dee listened to her and also took her medical history into account, regarding the negative effect of the NSAID medication, shows that an effective level of care and empathy was shown in this situation.
    2. Jane will obviously be upset about the errors have been made but also about the manner in which she was treated. Dr Kerr’s dismissiveness of Jane’s concerns and then her failure to even apologise to her may also have left Jane feeling mistreated and uncared for, especially considering the misdiagnosis and prescription of medicine led to Jane’s condition worsening, as she has been left in unnecessary pain which could have been avoided.
    3. The Patient Safety breaches could have been avoided if Dr Kerr had taken more time initially to address Jane’s concern and made the correct recommendation for an X-Ray whenever Jane first went to A&E. Also, Dr Kerr should have paid more attention to the contradiction alert regarding the NSAID medication to prevent Jane from having unnecessary stomach pains on top of the pain in her ankle. Overall, had Dr Kerr spent more time with Jane and paid more attention to her concerns in the first instance, then the Patient Safety breaches may have been avoided.

  65. Anonymous says:

    1. Trust is a firm belief in the reliability, truth, or ability of someone. Patient’s – like Jane – place a lot of trust in doctors and the medical profession to provide them with the care and consideration that they require. The A&E doctor addressed Jane’s concerns and prescription in an unprofessional and ignorant manner which led to negative effects for Jane’s health. It can be suggested that Jane did not feel her concerns were properly addressed and she was not put first as a patient. Notably, this did not diminish Jane’s trust in the medical profession as she returned to her GP who reinstated her trust by providing the adequate treatment, listening to Jane as a patient and addressing her concerns.
    2. Errors were been made on behalf of the medical profession and Jane may be upset in how she was treated and the knock-on effects of this on her health and well-being. But is important to consider the social, environmental and psychological influences in the biopsychosocial model of health, which may be influencing Jane’s mood. For example, Jane may be upset as she is unable to go out running and maintain her social life, ultimately, this affects her psychological health too.
    3. The A&E doctor should have taken more time to perform a through examination and address Jane’s concerns and medication in a more professional, trustworthy and cautious manner. Also, the A&E doctor should have fulfilled the Duty of Candour requirements in being open and honest with Jane.

  66. Anonymous says:

    1. The behaviour of the two doctors in this scenario are very different. Dr Kerr was very busy and so hurried the appointment along making some errors in the process and also making Jane feel like she had not been listened to. This will damage Janes trust in the medical profession as she will associate all experiences with this bad experience and so will not want to return to the hospital if she takes ill again. On the other hand, Dr Dee was much more attentive to Jane and developed a better rapport with her, encouraging her trust in the medical profession as he listens to her concerns and takes them seriously..

    2. Jane would be upset because the mistakes that were made led her to be in more pain and discomfort. It is also likely that Jane would be upset because she felt like she had not been listened too and her concerns were not taken seriously

    3. The patient safety breeches in this case could have been avoided by listening to Janes concerns and giving her the appropriate attention and time in her consultation. Also the warning symbol on the computer when the NSAIDs were prescribed should have been taken more seriously.

  67. Anonymous says:

    1. The experiences Jane has had with the two doctors differ significantly. Dr. Kerr appeared rushed and dismissive of Jane’s concerns, which ultimately lead to the misdiagnosis of her condition. However, her GP was much more accommodating and attentive to her grievances. Her GP completed a thorough examination and communicated clearly when providing advice, which contrasts the quick examination that Dr. Kerr performed. This ultimately lead to the correct diagnosis being determined. As a result of these experiences, Jane may lose trust in hospital medicine and call into question the consistency and quality of care provided in hospitals. This may lead to Jane feeling apprehensive to go to A&E again and rather schedule an appointment with her GP, whom she knows and trusts.

    2. In addition to the errors being made in treatment, Jane may be frustrated due to the dismissive nature of Dr. Kerr from the first appointment as well as her knowing that these faults could have been avoided if Dr. Kerr had listened to her and not overlooked the alert in relation to the NSAID medication. Furthermore, Dr. Kerr ignoring Jane upon arriving to A&E again may have also caused frustration as an apology would have outlined the reasons for Dr. Kerr’s mistakes, thus, allowing Jane to understand that Dr. Kerr genuinely cares about her well-being and has learned from this error, which may have improved her confidence in hospital treatment.

    3. The Patient Safety breaches could have been avoided if Dr. Kerr had taken more time and had completed a more thorough examination in the first appointment. This would have led to the appropriate request of an X-ray and further accurate diagnosis. Also, Dr. Kerr should have listened to Jane’s concerns about her experience and pain levels and took this into consideration. In addition, the warnings over Jane’s previous stomach ulcers and the prescription of NSAID medication should have been respected to avoid further harm to Jane, beyond the fracture in her ankle.

  68. Anonymous says:

    1. Dr Kee appeared to be very rushed and didn’t partake in a full examination when Jane first arrived in A&E. She didn’t listen to Jane’s concerns and ended up misdiagnosing Jane, which has left her feeling let down by the NHS and wishing to complain. Also, when Dr Kee realised she had made those mistakes, she never consulted nor apologised to Jane, making Jane feel upset and that the doctor doesn’t care about her.
    On the other hand, Jane’s GP Dr Dee, carried out a full examination of her injury and listened carefully to Jane’s ideas and concerns. She advised her to stop taking the medication for the best, which helps to resolve Jane’s stomach ulcers. This shows that listening to the patient and obtaining a recount of what occurred lead to a proper diagnosis, meaning Jane could trust and have confidence in Dr Dee.

    2. Errors were made in Jane’s case, alongside Dr Kee not fully listening to her and dismissing her ideas and concerns. Also the fact the A&E Department was busy that day didn’t help as it caused Dr Kee to rush and spend little time examining Jane’s injury. Additionally, Dr Kee never acknowledged the contraindication notification on the system when she was prescribing the NSAID medication. Dr Kee never apologised to Jane for her mistakes and pretended to not notice her, which left Jane feeling upset and that she wasn’t treated in a respectful way. Jane may also feel upset as she has to return to hospital again 11 days after the original injury and feels she could be dismissed again.

    3. Patient Safety breaches in this case could have been avoided if Dr Kee initially spent a little longer listening to Jane and obtaining a full history from her. This would have avoided a misdiagnosis and Jane having to go to her GP and seek her opinion. Also, Dr Kee should have properly read the contraindication alert on the prescribing system, which would have prevented Jane from developing stomach ulcers. Overall, these breaches could have been avoided if Dr Kee had spent more time with Jane by fully examining her and listening to her story at the very first instance.

  69. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Jane faced two different experiences with each doctor. Dr Kerr treated Jane quickly and dismissively, as she was prioritising time management to see as many patients as possible instead of prioritising a good quality of care and patient safety. This led Jane to feel her opinion about her own treatment had not been taken seriously. Dr Kerr also ignored the warning signs about giving Jane the NSAID medication which could be said was careless and unsafe for the patient. Nevertheless, Jane trusted the doctor’s judgement and put up with the pain of her ankle for 11 days as it got gradually worse and red.
    Janes experience with Dr Dee was very different. Dr Dee took the time to assess Jane thoroughly even though the GP practice was also very busy which showed a level of commitment to Jane and carried out the correct procedures to stop Janes condition worsening. Dr Dee communicated well with Jane and listened to Janes concerns with empathy. It is clear that Dr Dee had more success in diagnosing Jane correctly because she compassionately listened to Jane, examined Jane thoroughly even under time constraints and took every little detail serious that Jane was telling her.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    There were multiple reasons could’ve been upset about her treatment. The first may be that she was not given enough respect during her first visit to A and E because her concerns were disregarded, and the doctor alienated her from her diagnosis and treatment plan. This led to her second reason to be upset which was that her condition ended up getting worse and affecting her day to day life which included her mobility and appetite. At this point I imagine Jane felt scared and vulnerable so to go back to the doctor after such a negative experience would’ve made Jane anxious. Lastly, I imagine Jane felt frustrated after hearing that she had received the wrong diagnosis leading to her being in unnecessary pain for 11 days. Having received no apology about this would also be quit upsetting for Jane as she may worry a mistake like this could happen again if it is not properly addressed and that would affect her doctor-patient relationship.
    3. Suggest how the Patient Safety breaches in the case could have been avoided
    Dr Kerr should’ve not rushed the first consultation and should’ve taken time to assess Jane thoroughly and listen to the patients concerns. Dr Kerr should also have not ignored the warning signs on the computer about giving Jane certain medication due to her previous medical history as this was unsafe. If both these incidents were altered it could’ve led to Jane receiving the correct diagnosis and treatment first time round.

  70. Anonymous says:

    1. Dr Kerr should have been more responsible and apologize after he acknowledged where he went wrong, he was a good listener, he managed to loose Jane’s trust, his diagnoses lead Jane health to worsen instead.
    which will lead Jane to question her trust in heath professionals In the future making her think that she will experience the same thing.

    2. Jane was disappointed the anxious that her concerned were missed by Dr,kerr, where to her it could have been totally avoided if she was listened too carefully with proper history taking.
    3. patient safety is very important and because dr Kerr was rushing through the consultation the stress lead him to give false treatment.

  71. Anonymous says:

    1.Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Dr Kerr appeared to be very rushed and completely dismissed Jane’s concerns. Even though she had suffered from sprains in the past, the doctor did not take into account 1. Jane’s knowledge on the condition. The doctor prioritised time management over the safe and effective treatment of her patient and unsafely prescribed the NSAID medication, despite being given warnings by the computer system. Ultimately, Jane was extremely unhappy after leaving the A&E department. In contrast, Dr Dee carried out a thorough examination and ensured that all of the appropriate actions were taken to prevent her condition from worsening. Dr Dee was much more respectful towards Jane as a patient and ultimately made it mush easier for Jane to trust in her as her doctor. On the other hand, she was unable to trust in Dr Kerr due to her dismissive attitude and rushed treatment.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Jane is evidently in a lot of pain and experiencing a great deal of discomfort. Jane is quite rightly upset due to the manner in which she had been treated. She was unsafely prescribed medication, wrongly diagnosed and her concerns as a patient were not respected.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    It is understandable that doctors will become stressed when confronted with large waiting lists. However, they must ensure that they do not allow themselves to be rushed and carry out unsafe practise. Healthcare professionals should take an appropriate amount of time to take a detailed history from their patient so that the correct diagnosis can be found.

  72. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    There is a clear distinction between the behaviour of Dr Kerr and Dr Dee evident through their contrasting approaches towards Jane’s situation. Dr Kerr dismissed her concerns that her injury was more than an ankle sprain. In addition, Dr Kerr only spent a limited amount of time with Jane, rushing through her examination. Dr Kerr also didn’t give the patient a say in her treatment by ignoring her requests for an x-ray to take place. Dr Dee, on the other hand, took time to evaluate the situation and recognised that Jane had never felt such pain before. It is clear that listening to the patient led to a correct diagnosis whereas ignoring the patient’s thoughts led to the incorrect diagnosis and the inappropriate treatment.
    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Due to the completely avoidable nature of the error, and the fact that Jane was left in a considerable amount of pain, she is obviously very upset. As well as the error that was made Jane is likely to feel upset due to the manner in which she was treated. Her concerns were ignored and overlooked despite being an experienced runner. No apology was given for the error which would naturally cause Jane to feel more upset decreasing her trust in medical professionals.
    3. Suggest how the Patient Safety breaches in the case could have been avoided
    Patient safety breaches could have been avoided if Dr Kerr had not rushed the initial consultation and had taken the time to listen to what Jane had to say. This would have potentially led to the correct diagnosis and prescription. The dismissal of the drug warning should not have been ignored and it should not have been assumed that every alert was for insignificant issues. Dr Kerr would’ve seen that NSAID was not appropriate for Jane so reading these alerts would have prevented this mistake.

  73. Anonymous says:

    1. I think the behaviour of the doctors will affect Jane.s trust in the profession both positively and negatively. On the one hand, Dr Kerr didn’t seem very compassionate towards Jane, and wasn’t taking her complaints too seriously. She also ignored the alert warning as well that lead to Jane having a negative reaction from the NSAIDs. All of this caused a delay in the treatment of her injuries and prolonged her suffering, potentially worsening her condition and reducing her quality of life. This will result in her loosing trust in A&E department and will potentially preventing her from using this service again. However, Jane’s GP was very compassionate and listened to her symptoms and took her very seriously. This resulted in the correct diagnosis and a treatment plan in put in place. This would make Jane feel very satisfied with the service from the GP and would enhance the trust she has in this service, potentially encouraging her to seek help again if she requires it.

    2. I feel Jane is upset as her concerns were not listened too and taken seriously, resulting in the delay of her treatment and causing her significant suffering. Jane feels as though she didn’t have a say in her treatment and as a result has had a negative experience with the doctor.

    3. Patient safety breaches could have been avoided if Dr Kerr had listened to Jane and taken her concerns more seriously. The pressurised environment caused Jane’s consultation to be rushed and an alert message was skipped over, resulting in the wrong treatment being prescribed which actually resulted in more harm. Improved communication between Dr Kerr and Jane could have possibly avoided this situation.

  74. Anonymous says:

    1. Dr Dee’s treatment of Jane is first class – he fits in an appointment, listens carefully and carries out a thorough examination. Based on his knowledge and clinical findings, he arranges a prompt follow up x ray and prescribes appropriate pain medication, despite being very busy. This level of care and efficiency is likely to increase levels of trust between doctor and patient.
    As an A&E doctor, Dr Kerr does not have the same level of background knowledge relevant to Jane’s circumstances. However, various mistakes including ignoring concerns raised, prescribing inappropriate medication and essentially leaving Jane on her own without any kind of follow up will no doubt cause her to have a lack trust and confidence in the medical profession. This, in turn, could lead to Jane failing to divulge medical information in the future, and even not going to see a doctor despite needing care.
    2. Doctor Kerr compounds her original error by pretending not to see Jane when she comes back to A&E. Even when she realises she has made a mistake she does not apologise. The failure to offer an apology of any kind is likely to add to Jane’s hurt and will confirm in her mind that she has not been dealt with in a respectful way. This is likely to cause a deterioration in the doctor-patient relationship. In addition, Jane’s original concerns were ignored – this lack of “patient-centred care” may leave Jane feeling not valued, having been excluded from an involvement in her own treatment.
    3. The system alert needs to be more closely monitored to prevent doctors “overriding” system messages. In addition, a treatment plan post A&E may help to identify and rectify any serious problems. Also, if Dr Kerr hadn’t ignored the contraindication alert the about the NSAID medication the nausea and loss of appetite may have been avoided.

  75. Anonymous says:

    1. The behaviour of the doctors is significantly different and thus will likely result in Jane’s trust within the medical profession being compromised. As a result of Dr Kerr not allocating enough time to Jane, a misdiagnosis was made, alongside ignoring the contraindication warning given by the computer at the time of discharge. If Dr Kerr had made more of an effort to discuss Jane’s previous medical conditions, this may have been avoided. Finally, the lack of apology when Jane was re-admitted to hospital was inappropriate. Having experienced this treatment, Jane may feel disappointed and concerned about the treatment she received. Jane may feel less inclined to seek treatment again as she wasn’t listened to effectively, which may result in health deterioration. She may also feel that some doctors are incompetent in their role and not accountable, suggesting that the care provided may be highly inconsistent. In contrast, Dr Dee was able to listen to Jane carefully about her concerns. It was also wise to discuss the multiple factors that may be causing her symptoms. Dr Dee was thorough in her examination and appropriately suggested an X-ray, leading to the correct diagnosis. Jane may feel very confident and supported in the primary care she received, particularly as Dr Dee allocated enough time to discuss her medical history with her. Additionally, the fact that the doctor was able to consult with Jane on a busy day, displays a level of commitment and care that may help Jane feel reassured in the ability of the doctor and their competency to help her. This may help Jane to build trust with the medical profession, and feel more comfortable to interact with them in future experiences.
    2. There may be many reasons why Jane is upset. She potentially may not even be aware of the multiple errors that were made in her treatment. She may feel upset that she wasn’t listened to appropriately when she first visited the hospital, or that she was disregarded by the doctor. She may also feel anxious about returning to hospital for this reason. The lack of apology may also be upsetting, as she may be concerned that she will experience a similar situation and possible errors may be repeated again.
    3. If Dr Kerr had taken more time to speak with Jane and conduct a full examination and medical history prior to discharge, the misdiagnosis may have been avoided. Pressurised working environments should not encourage taking shortcuts in treatment. Dr Kerr should also have not ignored the contraindication warning on the computer when prescribing the medication, as the fact that it could disturb Jane’s stomach may have been identified and avoided. A more suitable medication could have been found. The lack of apology on the doctors behalf is indicative of a lack of self-reflection and may suggest that the mistake is likely to re-occur.

  76. Anonymous says:

    1. Dr Kerr’s behaviour: This doctor was abrupt to discharge Jane. They did not consider the incompatibility of NSAID medication with Jane’s body. The effect this behaviour led to Jane thinking the hospital’s care was insufficient, and Jane sought help elsewhere.
    Dr Kerr also did not approach or apologise to Jane for the error that caused her harm, so Dr Kerr did not take responsibility for her actions. Because of this, it would have reduced Jane’s confidence and trust in the medical profession, leading to her decision to make a complaint.

    Dr Dee’s behaviour: In contrast, Dr Dee was attentive by ‘listening carefully’. She reflected on what Jane was saying and likely asked relevant questions to get to the proper diagnosis. Dr Dee also performed a ‘thorough examination’, being meticulous and not leaving seemingly insignificant details out of consideration. This was effective because she resolved the problem by ‘prescribing an alternative pain medication’, and got Jane the correct treatment. Despite this, Jane still felt let down by the overall standard of care from medical professionals and this caused significant delays in treatment.

    2. Jane felt ‘ignored’. Initially, the first doctor failed to focus on the significance of her concerns. As Jane’s opinions were overlooked, she felt unimportant. This would have made her upset.

    3. The breaches could have been avoided by reading through the drug alerts on the system, and not assuming every alert was for insignificant problems. Dr Kerr should have also thoroughly checked Jane in person herself before discharging her.

  77. Anonymous says:

    The initial doctor at A&E will have damaged Jane’s trust in medical professionals as it will create a lasting impression that a busy doctor does not care and is not doing their job sufficiently well. She may also be feeling upset as when she expressed concern due to the pain and requested an X-ray she was passed off.
    The GP will have made Jane feel validated and heard. With a history and proper examination taken place, a better outcome had occurred with Jane being referred to receive the required treatment. Due to this interaction, Jane will have built rapport with her GP and trust him/her to act in her best interests.
    Jane will be feeling upset due to the errors made and receiving medication that has made her pain more severe. Although aside from physical pain, she will have felt dismissed and not respected.
    This could all have been avoided by dedicating more time and not rushing through, history taking and examination, alongside investing time to read the computer contraindication alert.

  78. Anonymous says:

    1. The first doctor (Dr Kerr) would greatly reduce Jane’s trust in the medical profession as not only did she wrongfully dismiss Jane’s concerns about her ankle but she also ignored Jane when it was obvious that they had both seen each other upon Jane’s return. This came across as rude and disrespectful towards the patient. However, the behaviour of Dr Dee may renew Jane’s trust in the medical profession. This is due to the fact that Dr Dee takes the time to deal with each of Jane’s concerns despite the busy waiting room. As a result a correct solution is found for each of Jane’s problems. Overall this could still undermine Jane’s trust in the profession as she has been treated wrongfully and therefore may not know who to trust in future.
    2. Although the errors added to why Jane was upset it was not the only cause. Jane’s opinion was overruled with regards to her pain and any input into her care was not listened to when she proved to be correct. Moreover, she may have been upset due to the rude attitude of Dr Kerr when she deliberately ignored her and refused to apologise even though she was clearly in the wrong.
    3. Patient safety was undermined from the beginning when Dr Kerr disregarded the injury as anything serious. Sending Jane away could have worsened her injury and possibly caused more permanent damage. Moreover, due to the ignorance of the computer message and the way the doctor rushed meant that medication was given with a detrimental effect to Jane’s health causing even more pain. These issues could have been avoided by taking the time to listen to the patient, being more thorough in revision of the patient’s notes or by reading the contraindication alert on the computer.

  79. Anonymous says:

    Firstly Dr Kerr would have affected Jane’s trust in the profession because she gave the same information to her as she did to Dr Dee and she wasn’t diagnosed properly and she may have felt ignored and not listened to. This may lead her to believe that when she goes to the GP or sees a doctor in the future she might not be diagnosed properly and she may feel worried that something worse might happen the next time as a result of vital information being overlooked or missed. Dr Dee on the other hand listened to Jane more carefully and examined her more thoroughly despite having the same time to examine her as Dr Kerr.

    Jane would be upset because of having to deal with even worse injuries than she initially had because of being misdiagnosed. She may also feel upset because she has developed stomach ulcers due to NSAID being prescribed when they shouldn’t have been. She may be mostly upset because Dr Kerr didn’t come to apologise to her even though she seen Jane return to the hospital in a worse condition than before. If Dr Kerr had apologised to Jane and said that he would learn from his mistakes that may have uplifted her and helped her mentally heal and allow her to be content that the same scenario won’t happen again.

    Patient safety may not have been breached if Dr Kerr had listening skills in treating Jane he may have picked up on vital information for her diagnosis. Also if Dr Kerr had been more meticulous in checking whether NSAID would harm Jane she probably wouldn’t have been prescribed that drug and an alternative more effective anti-inflammatory drug could’ve been prescribed.

  80. Anonymous says:

    1. The behaviour of the two doctors contrast each other so Jane would lack confidence in visiting doctors again, since she can’t be sure that the doctor’s opinion is correct and would be worried about another wrong diagnosis like this one that could cause her more harm. Jane may start to distrust the hospital since it was there that the doctor made the misdiagnosis and therefore she might start avoiding visiting even if she feels she needs to, which could exacerbate her symptoms and cause her to become more unwell than she would have otherwise.
    2. Jane would have probably been more upset at the fact that her concerns weren’t listened to by the original doctor, and that because of this she had to spend 11 days in severe pain rather than getting it addressed from the beginning. She would also likely be upset by the fact that the doctor did not offer an apology, as this would have made Jane feel that her feelings and suffering was acknowledged.
    3. Listening to the patient’s concerns would have been the first step in avoiding this problem, since the doctor knows the background medical knowledge but the individual patients know their own body and how they are feeling. The warning message should have been properly investigated, even though the department was busy, since this would have prevented the NSAIDs being prescribed and would have prevented Jane from becoming more ill due to a flare up of stomach ulcers.

  81. Anonymous says:

    1. The attitude of the two doctors is in contrast. Dr. Kerr who was in a rush in treating Jane by prescribing the NSAID medication even though it’s sated in the computer system that she was not allowed to receive that medication due to past history stomach ulcer is in ethically inappropriate. This would impact Jane’s trust in the medical profession especially when Dr. Kerr found out that she made a mistake and did not do anything about it. Dr. Kerr should have apologized to Jane. On the contrary, despite being busy, her family GP, Dr. Dee, still managed to take some time to listen to her worries and examine her thoroughly. This clearly shows that Dr. Dee is patient-oriented and always takes his or her patients at heart by treating them as an individual. She might be left in a difficult situation next time around where she does not know whom to trust in the future when she needs to seek medical professional help or advice.

    2. Jane was disappointed with the fact that error was made and Dr. Kerr did not even have the courtesy to apologize to her. Knowing the fact that he or she had made a mistake, he or she just ignored Jane when Jane came by to the A&E department for further examination. Dr. Kerr should have apologized to Jane personally and explain what he or she can do next to treat Jane’s fractured lower limb.

    3. Dr. Kerr should never have compromised the worries and signs given by Jane even though knowing that he or she would be busy. Jane should be treated as an individual at all times. Even though mistakes have been made, Dr. Kerr should admit it and always apologize to Jane and explain the next steps to take instead of ignoring Jane for the sake of his or her own image.

  82. Anonymous says:

    1) The trust Jane has in the medical profession may have been compromised by Dr. Kerr not listening to her when she initially came into A&E and rushing through her consultation. The fact that the pain medication had not alleviated her pain but had also resulted in irritability in her stomach could have meant that her trust was more tarnished as she may have felt that her presenting complaint was not taken seriously and was just brushed off. The fact that Dr. Dee overruled Dr. Kerr’s initial decision could mean that Jane is confused as to if she really should be trusting all doctors, as she was led to believe that there was little wrong with her when in fact her diagnosis was a lot more serious. She could start to question the legitimacy of doctors working as a team as they both contradicted each other, and so therefore her overall trust in the doctor-patient relationship could decrease.

    2) Jane is not only upset by the fact that there were errors made, but by the fact that her opinion was not listened to and that the alert was ignored that resulted in her stomach pain which was not a complaint that she had presented with initially. She is also upset by the fact that the doctor who had made these errors, Dr. Kerr, did not have the bravery and professionalism to stand up and admit she had made a mistake and apologize for it.

    3) The patient safety breaches shown here could’ve been avoided if Dr. Kerr had taken time to listen to what Jane had to say at the initial consultation and sent her for an x-ray to rule out a fracture, even if she did believe that it was only a sprained ankle at the time. She should also have taken the time to acknowledge the alert which appeared on the screen to ensure that the drug she was prescribing was safe for the patient to use. This would not have taken an awful lot of time on the day and could’ve potentially saved time later on.

  83. Anonymous says:

    1. Both doctors behaved differently with different treatment options towards the situation hence it will make Jane more likely be confused about who to trust. The impact of negative experience caused by Dr Kerr can affect Jane’s future consultations in the hospital. Jane may feel that the care provided at the hospital is inadequate compared to the one she received from the GP surgery.

    2. Jane could also be upset from not being acknowledged and receiving an apology from Dr Kerr as the doctor never took the patients opinion into consideration.

    3. Double checking the automatic alerts, acknowledging and responding to patient concerns

  84. Anonymous says:

    1) The experiences with both doctors differed greatly, making it likely that Jane will be confused about what advice to take in the future. The experience with Dr Kerr may result in Jane being reluctant to return to A&E in the case of an emergency, which is understandable due to her misdiagnosis and treatment. Jane may feel that if her concerns had been taken more seriously there would have been a better prognosis. However, by Dr Dee taking the time to get a full history, recount of the accident and performing an examination her faith in primary healthcare is expected to be stronger than what she would have in secondary healthcare.
    2) Due to the fact that Jane’s original concerns were not taken into consideration when treating her injury and the errors made resulted in late diagnosis which has caused her to be in pain for a considerable duration of time.
    3) If Dr Kerr had taken a few extra minutes during the consultation and taken the patients concerns seriously, it may have resulted in a better prognosis for Jane. The dismissal of the drug warning should not have been ignored.

  85. Anonymous says:

    1.There is a very evident contrast between the behaviour of the two doctors , on one hand we have her GP who irregardless of how busy he was took time to read up on history and conduct a thorough examination , which the ER doctor failed to do so.This would understandably lead Jane to harbour some distrust in the profession.She might now doubt every doctors diagnosis based on this experience .Her positive experience with the doctor that knows her well as opposed to her negative experience with the hospital A and E doctor could lead her to only trust certain section of the medical profession.

    2.The fact that errors were made would possibly upset her but the other factors too certainly upset her , for one the doctor not listening to her concern for whatever reason and brushing past her ideas would’ve upset her more than the error.Furthermore the A and E doctor not going forward and apologising or acknowledging her would’ve made her feel as if the doctor doesn’t care

    3.Patient safety breaches in this case could’ve been avoided by the doctor taking time to talk to patient calmly and taking into consideration the patients concerns .Mismanagement of medication could’ve been avoided by the doctor not ignoring the contraindication warning this again points to the doctor missing things cause they didn’t take enough time with the patient and did not work systematically with the patients issue .

  86. Anonymous says:

    The A+Et doctor never listened to her concerns.The delay in appropriate treatment might have resulted in irreversible damage to her ankle.NSAID can be very dangerous for patients who suffer from stomach ulcers . This wrong prescription also could have potentially put her life in danger. Complication arising from stomach ulcers are serious and even may lead to perforation. However in contrast holistic approach towards Jane’s concerns by her GP made her feel safe and heard. But yet it is important to remember that GP surgeries can be quite busy and there was a chance that Jane could not book an appointment and therefore her current condition could have become worse and eventually life threatening.Above all when mistakes are made it is essential to apologise to patients and to acknowledge that mistake was made. Inappropriate behaviour as such can really damage the public trust in healthcare.Finally if the operation doesn’t go as planned and patient ends up with long term damage or any problem the A+E doctor may be questioned by the hospital and also GMC or other regulatory bodies. This also can adversely affect the doctor’s reputation and future career.

  87. Anonymous says:

    1. The behaviour of the two doctors will undoubtedly negatively affect Jane’s trust of the medical profession. The differing diagnoses made by the two doctors will create a nagging worry in Jane’s head if she or any relatives were to return to the hospital. This nagging worry will make her unsure of any doctor in the future as she will feel the need to get a second opinion. Dr. Kerr’s inability to listen to Jane’s concerns led to a misdiagnosis, and worsening of her injury. The lack of apology also aggravated the situation as the doctor refused to acknowledge his mistake, making Jane much more upset than she would have been had the doctor owned up to his mistake. The actions made by Dr. Dee on the other hand reinforced Jane’s trust in the medical profession as he was attentive, knowledgeable, and provided her with an in-depth consultation that led to a correct diagnosis.

    2. Jane is likely upset at more than just the errors made. I believe that she is also upset that her concerns were not taken seriously and that she was made to feel as one in a crowd of patients as opposed to an individual patient with individual concerns and the right to a fair consultation. In addition, she is likely to be upset that she has to undergo surgery 11 days after the injury occurred. Had the injury been dealt with in a correct manner the first time she came into A&E, it is likely that she would not have returned a second time. Lastly, Jane is also affected by the lack of apology from Dr. Kerr, knowing that she pretended not to see her. This implies to Jane that Dr. Kerr is refusing to acknowledge her mistake.

    3. Dr. Kerr should not have rushed the initial consultation in order to be able to see more patients. She also should not have ignored the drug related warning, no matter how insignificant it may have seemed. This alone could’ve prevented aggravating Jane’s stomach through the NSAID medication. This mistake worsened Jane’s pain and created problems that did not already exist in the first bc consultation.

  88. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    The behaviour of the A&E doctor was rash and inconsiderate, especially when they didn’t apologise for the mistake they make. On the other hand the GP, despite being busy, made all the correct decisions and listened to Jane, prescribed medicine correctly according to her medical history and referred her to the radiologist even though they weren’t certain she had a fracture. Because of this Jane may have opposing views to specialty doctors with their lack of concern and action and GP’s who were trustworthy and concise with her issues.
    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Jane’s well being physically wasn’t the only thing affected. She specifically told the A&E doctor she didn’t think it was a sprain and she wasn’t adequately listened too. Which in the end turned out to be what actually happened. She must feel frustrated for the lack of care she received.
    3. Suggest how the Patient Safety breaches in the case could have been avoided
    If the doctors don’t ignore the drug alerts no matter how many times they have popped up for insignificant reasons. It doesn’t validate negligence.

  89. Anonymous says:

    1. Jane’s trust in the medical profession would decrease due to this experience because the care she was given was inconsistent since one of the doctor’s misdiagnosed her and sent her home with a medication that caused her more pain. She would become more reluctant to be open with her doctors because she may feel that they do not listen to her; for instance, how the A&E doctor ignored the contraindication alert given to her.
    2. Possibly, along with the errors made, Jane could also be upset and frustrated because her first doctor did not apologise for her mistake. She would’ve felt better if her doctor owned up to her mistake and promised that it would not happen again. In addition, it could also be the fact that she was in a lot of pain and the long time it took for her to get cured that put her in a sad state.
    3. Patient Safety breaches could have been avoided if the A&E doctor did not assume and jump to conclusions that the contraindication alert was not a serious one and ignore it. Instead, doctors need to be more vigilant and not let the pressure of their surrounding affect their work since patient safety comes first in everything a doctor does.

  90. Anonymous says:

    1. Jane’s interaction with the A&E doctor may have damaged Jane’s trust in the medical profession as the doctor rushed and did not take adequate time to assess Jane’s ankle and listen to her concerns resulting in the incorrect diagnosis and prescription of the wrong medication. However, Jane had a very different and seemingly positive interaction with her GP who took the time to listen to Jane and address her concerns which may make Jane trust her GP more. Overall, Jane’s trust in the medical profession has likely deteriorated and this may make it less likely for Jane to come back to the hospital in the future.
    2. Jane is likely also upset about how rushed her appointment was with the A&E doctor and that this doctor didn’t fully listen to Jane and address her concerns which may have prevented Jane from becoming so unwell. Jane may also be upset that Dr. Kerr had the opportunity to apologise to Jane but chose to say nothing.
    3. More time could have been taken during the first appointment to fully listen to Jane and do an X-ray to give the right diagnosis and prevent Jane’s prolonged pain. Also, the drug alert should have been acknowledged and the NSAID not given to Jane so her painful stomach didn’t happen.

  91. Anonymous says:

    1. Dr Kerr was dismissive of Jane’s concerns and the lack of a thorough examination and prescription of inappropriate medication have led to Jane losing her trust in this particular doctor and, by association, other A&E staff. In contrast Jane’s Primary Care physician took the time to make Jane feel appropriately listened to and took the steps to correctly diagnose Jane and rectify the previous errors. This may have increased Jane’s trust in her GP, and reinstated her trust in the medical profession as a whole.
    2. In addition to the errors that were made, Dr Kerr dismissed Jane’s concerns, making her feel like a number on a waiting list rather than a patient with a problem, unlike Dr Dee who listened to all of Jane’s concerns, allowing the correct diagnosis to be made. It was this lack of compassion towards Jane that contributed to her upset.
    3. By Dr Kerr initially taking the time to thoroughly examine Jane and listen to her concerns, rather than dismissing them, the correct diagnosis could have been made. A more thorough history taking and the information revealed by building a greater rapport with Jane may have highlighted to Dr Kerr the reason why the NSAID medication was flagged by the computer, allowing her to provide an alternative form of pain relief. Dr Kerr also could have recommended attending Jane’s GP if her symptoms worsened, meaning Jane wouldn’t have been in pain for as long.

  92. Anonymous says:

    1.) The behavior of the two doctors is likely to harm Jane’s trust of the medical profession especially since the advice and treatment provided by the two doctors differed quite significantly. Jane is perhaps more likely to trust the opinions and judgment of doctors within the primary care setting as opposed to those doctors working within hospitals and in particular A & E.

    2.) Jane is likely to feel upset due to the misdiagnosis but also due to the manner in which she was treated. Jane’s concerns about her ankle were ignored and dismissed despite having experience with ankle injuries as an experienced runner. Jane has also yet to receive an apology from Dr Kerr who made the initial misdiagnosis which will only contribute to her feeling ignored and sidelined.

    3.) Patient safety breaches could have been avoided if more time had been taken during the initial consultation, this might have resulted in a more accurate diagnosis. Moreover if Jane’s concerns had been taken into account during the initial consultation it is more likely that the A & E doctor would have ordered the necessary diagnostic tests (e.g. X-ray). Dr Kerr should also have responded more appropriately to the contraindication alert and not simply ignored it due to time restraints.

  93. Anonymous says:

    1. The behavior of the two doctors will negatively impact the trust Jane has on the medical profession. This is not only because the diagnoses made by the two doctors were different, but also because of the fact that Dr.Kerr did not listen carefully to Jane when she recognized that the pain was not due to a sprain. Jane’s trust in the medical profession must have reduced as she suffered more pain due to a misdiagnosis and has to go through a surgery that could have been avoided. Jane would now be more likely to seek second opinions from other doctors before starting any medications for any other disease she might develop in the future. Although the second doctor made the right diagnosis, no sort of apology/ communication was delivered by the first doctor. This further worsens the situation as it makes Jane feel as if the doctor ignored her mistakes and is not willing to accept them to Jane

    2. The errors made by the first doctor is mainly why Jane is upset as she must go through surgery now. However, there are other reasons that made Jane upset such as the ignorance of the doctor. Since the doctor did not take responsibility for her actions that caused a lot of inconvenience to Jane, this might make Jane feel as if her concerns were dismissed.

    3. If the doctor had not rushed through the consultation, these issues could have avoided. A follow-up consultation after a couple of days to check for improvement might have reduced the number of days Jane felt sick due to the NSAIDs. Although it can get extremely busy in the A&E, it is important that doctors do not dismiss any important information.

    Computer system failure- fixing those issues on time, double-checking with the patient regarding any allergies or side-effects the patients experience before prescribing the drugs

  94. Anonymous says:

    1)The contrasting and contradictive behaviour of the two doctors will undoubtedly negatively affect Jane’s ability to freely place her trust in the medical profession. Particularly when in a hospital, as the care in the GP clinic was significantly better. On top of this, no apology or explanation was given to Jane, further deteriorating her ability to trust. This may lead to Jane refraining from going to a&e in the future because it left her worse off than before.

    2)Errors were made than contributed to worsening Janes condition, but no apology was given either, which would naturally make Jane more upset. The healing process has now been significantly delayed, and affecting Janes daily life, for example, she likes to run but is now unable to do so. This could further contribute to her feeling more upset and annoyed and damage her mental health. Janes concerns were disregarded, further damaging her ability to trust in the medical profession. Jane may feel as though if her initial concerns had have been regarded then these errors would not have occurred.

    3)Dr Kerr should not have rushed the initial consultation, this is where I think the first mistake has been made. The GP was also in a busy environment but was able to deal with it more efficiently and listen to Janes concerns- Dr Kerr did not and made this obvious to the patient. A few more minutes taken to listen to the patient could have proven to be all the difference and avoided Jane in waiting a further 11 days to receive the correct diagnosis. The inability to acknowledge the warning of the medication was another vital mistake that should not have happened, leading to worsening of the condition and pain. Perhaps a better system needs to be put in place or updated to prevent this. However, each alert, no matter how insignificant it may seem still needs to be investigated or taken into consideration even when it is busy because ignoring this can lead to more harm and significantly damage patient safety.

  95. Anonymous says:

    1) Dr Kerr’s brief consultation and misdiagnosis could cause Jane to lose trust in Dr Kerr and the profession as a whole. Dr Dee’s care on the other hand would help Jane keep her trust in the profession. Dr Dee’s in-depth consultation helped to get the proper treatment and care for Jane, as well as showing her that the she cares for the patient’s interest.
    2) Jane may be upset as she has suffered tremendous pain over the long time suffering with her injury. Also, the fact that she cannot enjoy running which she loves doing could be mentally affecting her as well.
    3) Dr Kerr shouldn’t have overlooked the warning relating to prescribing the NSAID medication and should have taken it into consideration. This would have prevented the illness of Jane’s stomach. Furthermore, Dr Kerr should have taken her time when consulting with Jane as this would have let to the correct diagnosis.

  96. Anonymous says:

    1) As a non medical professional, Jane would expect the views and practice of two doctors to be very similar, and would expect the same high level of treatment regardless of what state of stress or tiredness the doctor was in. Therefore the two very different views of the doctors (e.g. the prescription of the NSAIDs) may have made her more wary and less trusting of the medical profession as a whole.

    2) Due to the completely avoidable nature of the error, and the fact that she was left in a considerable amount of pain, Jane is obviously very upset. On top of this however, she was also dismissed and patronised (and later not apologised to) by the A&E doctor which would have made her feel rubbish.

    3) Patient safety breaches occurred due to rushed and stressed doctors not having the time to do their job properly and not listening to the concerns of the patient. These could have been avoided by having more staff in A&E, more time allowed for each consultation, better systems in place for drug interactions and better teaching and guidelines on listening to concerns of patients.

  97. Anonymous says:

    1. There is a stark contrast in the behaviour of the two doctors. Despite both being busy and under time pressure, Jane clearly received very different care from each. Dr Kerr seems to have almost allowed the busy environment and stress to have influenced how they delivered care. For example, they did not take note of the contraindication alert (however this seems to be a systems failing as it appears for ‘insignificant problems’) and seemed to have rushed through their diagnosis of Jane, not listening to Jane’s opinion and thoughts. Contrastingly, Dr Dee took time to give a full examination and, crucially, listened to Jane when she described never feeling such pain before. It seems listening to the patient led to a correct diagnosis, while brushing aside Jane’s thoughts led to an incorrect diagnosis and inappropriate treatment. Such a contrast, while possibly increasing her trust in her GP, will most likely damage her trust in the medical profession.

    2. Jane is likely upset at more than just the errors made. In my opinion, Jane may be most upset at not having her concerns listened to and feeling betrayed while at her most vulnerable. In addition to this, there is a possibility Jane is upset that that the errors made led to an unnecessary increase in her pain and disruption to her lifestyle, for example, having to slide down the stairs on her bottom. Jane may also be concerned for future patients and the risk to them. Especially should they have a more serious illness that, if not detected, could be fatal.

    3. In this episode, the first breach of patient safety was Dr Kerr ignoring the contraindication alert. It seems to have been a systems error rather than Dr Kerr’s sole error as these errors are frequently issued. Perhaps a new system could be created using a quick-to-understand colour code system. That is, a red warning when there is a serious problem and an orange warning when the problem is minor. Another possibly breach is if a follow-up appointment for Jane had been arranged or if Jane was instructed to contact her GP if she didn’t improve in so many days, rather than allowing her to leave it 10 days. If this was the case, the breach could be avoided by carrying out these actions at the end of the consultation with Dr Kerr. The breach where Dr Kerr allowed her stressful environment to influence her treatment may be improved through courses and advice for

  98. Anonymous says:

    1. Dr Kerr failed to listen to Jane’s concerns regarding her ankle and as a result Jane felt ignored. In addition, the failure resulted in Jane having prolonged suffering when the issue could have been treated 11 days prior. Furthermore, the medication recommended caused further suffering due to a failure from Dr Kerr to comply to the drug system. This would result in Jane having a lack of trust in the industry as her patient needs were not at the forefront of the treatment with Dr Kerr due to the busy A&E. However, Dr Dee was attentive and addressed all of Jane’s concerns and did not dismiss them which makes Jane feel valued and cared for. Dr Dee was aware of the seriousness of the situation and ensured Jane was assessed for a fracture at the earliest possible time which would help restore Jane’s trust in the profession.
    2. The treatment of Jane will have accentuated the errors made. The failure to properly listen and take on board Jane’s account of the pain will have aggravated the feelings of upset due to Jane being correct about it being worse than a sprain and having reiterated this to Dr Kerr. By ignoring Jane, Dr Kerr will have made her feel annoyed and even more undervalued.
    3. Patient safety breaches could have been avoided if Jane’s concerns had been listened to by Dr Kerr instead of dismissed and this could have been achieved with a slightly longer consultation time. Furthermore, a sufficient history would have prevented safety breeches. Dr Kerr should have investigated the serious drug interaction as this put Jane in danger.

  99. Anonymous says:

    1. The behavior of doctor Kerr has most certainly diminished Jane’s trust in the medical profession. Although Dr Kerr works in a highly strenuous environment he still has a responsibility to put the needs of the patient first. The fact that doctor Kerr didn’t take Jane’s concerns about her pain and the severity of her injury seriously has more than likely left Jane feeling belittled and ignored. The subsequent prescription of NSAIDs by Dr Kerr for Jane’s injury even after a warning was displayed on the computer system about her history of stomach ulcers has no doubt reduced Jane’s confidence in Dr Kerr’s competence. To make things worse Dr Kerr ignored Jane once more, upon realising that he had misdiagnosed Jane and caused further harm. By not apologising to Jane, Jane now probably views doctors as arrogant individuals who cannot admit to their mistakes.
    However her GP took a more patient-centred approach to Jane’s care. He took on board Jane’s concerns about the pain and immediately performed a physical examination as well as sending her for an X-ray. Furthermore he also listened to her concerns about her stomach and by using her medical history decided on an appropriate course of action in respect to the NSAIDs. His caring manner and his willingness to listen to Jane and act quickly on her complaints have more than likely left Jane feeling valued and hopefully has increased her confidence in healthcare professionals.
    2. Although errors were made in terms of her diagnosis and in the prescription of NSAIDs I believe that Jane is more upset about Dr Kerr’s attitude towards her complaints. Dr Kerr didn’t take the time to listen to Jane and thoroughly dismissed her concerns, as well as her past medical history of stomach ulcers. To make matters worse Dr Kerr then intentionally ignored Jane, rather than apologising for his mistakes and reassuring Jane that she would learn from them. This has left Jane feeling angry, belittled and undervalued.
    3. The breaches in safety in this scenario could have been avoided easily. Although Dr Kerr is working in a busy environment, it is still vitally important to listen to the patient as a patient’s story and medical history provides clues for an accurate diagnosis. Furthermore Dr Kerr should not have ignored the warning about Jane’s stomach ulcers, regardless of how frequently minor warnings appear on the system.

  100. Anonymous says:

    1. The behaviour in both doctors is very different. Of course there is some differences in circumstances when Jane came to see them, however they are both stressed, time pushed Doctors. There is a big difference in how both doctors cared for Jane. Crucially Dr Dee listened carefully to Jane and took note of the fact that she had never experienced pain like this before. Dr Kerr however rushed the consultation without listening or allowing Jane to fully explain her accident. Dr Kerr ignored Jane when she told him that this pain was unlike any sprains she had previously, deciding he knew better. Jaynes trust in the medical profession was very affected by Dr Kerr as her condition unnecessarily worsened significantly because of the NSAID pain medication prescribed to her and the misdiagnosis of her presenting problem. Jayne may have sought after medical advice earlier if she hadn’t felt so dismissed and uncared for as a result of her previous experience with Dr Kerr. However Dr Dee listened to Jayne and performed a thorough examination regardless of the time constraints which would ultimately help restore Jane’s trust in the medical profession.

    2. I believe the main reason why Jane is upset is that not only was her presenting problem was misdiagnosed resulting in unnecessary suffering, her initial condition was made worse because of the medication prescribed. However there are many other factors contributing to Janes frustration. Some other factors could include Dr Kerrs dismissive attitude to her when she was explaining her accident. Dr Kerr not listening to her would’ve made Jane feel uncared for and insignificant which would be upsetting. Another reason could be that the Doctor didn’t apologise or even acknowledge her when she seen Jane in A&E when she knew what mistakes she had made. The lack of apology could’ve made Jane more upset with her situation as opposed to making it better.

    3. The patient safety breaches could’ve been avoided if Dr Kerr had taken extra time with Jane regardless of the stress and time constraints which ultimately impacted Janes safety at the initial consultation. This would’ve lead to the correct diagnosis and prescription. This would’ve prevented the level of pain Jane suffered during the time between her first and second time in A&E. If Dr Kerr had taken more notice of the drug alert then Jane wouldn’t have been prescribed that medication and wouldn’t have been feeling as uncomfortable. Also if Dr Kerr listened carefully to Jane and allowed her enough time to fully explain her accident and previous history then the mistakes and the breach of Janes safety could’ve been avoided

  101. Anonymous says:

    1. The behaviour of both doctors Jane has seen are very different and contrast each other dramatically. Dr Kerr, while A&E was very busy was clearly under pressure and rushed through the consultation with Jane, didn’t fully listen to her concerns and ignored/didn’t see an important note on Jane’s file before prescribing medication. Dr Dee was also working in a busy GP surgery and may have been feeling under pressure, however she took the time to listen to Jane’s concerns and address them, correcting the mistakes of Dr Kerr. It is important that even under pressure due to a busy clinic, important notes like Jane’s previous ulcer illness cannot be ignored. As a result of this Jane’s health has deteriorated and she may have lost trust in Dr Kerr and potentially the health care profession. The fact that Dr Kerr recognised Jane and her mistakes in treating her initially and did not address Jane, Jane has lost trust in the Dr. An apology or acknowledgement of misdiagnosis from Dr Kerr to Jane may have restored her trust and faith, and may not have lead her to be so upset or willing to complain to the hospital.

    2. The errors in Jane’s diagnosis and treatment I’m sure have a large part to play in why Jane is so upset and willing to complain, however I believe that because Jane felt she was not listened to and her concerns not fully addressed by Dr Kerr is the main reason why she is upset. As well as the fact that on her second visit to A&E she recognised Dr Kerr and didn’t say anything to her to reassure her.

    3. Patient safety was breached because Dr Kerr either ignored or didn’t pay attention to Jane’s notes, identifying that due to previous ulcer disease she was not fit for the medication being prescribed. The Dr was clearly under pressure due to how busy A&E was but there should be nothing that can potentially breach patient safety. In the future the Dr should take the time to read anything that is flagged up in the notes before prescribing medication in order to prevent further mistakes like in Jane’s case.

  102. Anonymous says:

    1) Dr Kerr’s actions were detrimental to Jane’s trust in the medical profession while Dr Dee may have partially repaired that damage. Dr Kerr did not make time to listen to Jane’s concerns nor read the alert regarding prescribing NSAID. This resulted in Jane feeling dismissed and subjected to unnecessary pain due to being prescribed NSAID and being sent home with the fractured ankle. Understandably, these errors will decrease the trust Jane places in the medical profession and potentially lead to Jane not fully engaging with doctors in the future. However, when Jane visited Dr Dee, she was listened to and appropriate advice was given; Dr Dee’s empathetic approach and good clinical judgement will help to restore Jane’s trust in the medical profession.

    2) The fact that errors occurred is not the sole cause of Jane feeling upset. Some other reasons could be the fact that Jane did not receive an explanation or an apology for the errors, Dr Kerr’s dismissive attitude, and inconvenience of the misdiagnosis.

    3) Patient safety breaches occurred due to Dr Kerr feeling overwhelmed by the workload and consequently rushing through the initial consultation, leading to Jane’s concerns being dismissed, incorrect medication being prescribed, and a misdiagnosis. Complacency could have also had a role in NSAID being incorrectly prescribed as this complacency may have led Dr Kerr to believe it is unnecessary to read the warnings issue by the computer upon prescribing certain drugs.These breaches could have been prevented had Dr Kerr had the time to listen to Jane and read the drug prescription warning. Perhaps increasing the staffing levels and/or further support, supervision, and training would help prevent such errors occurring in the future.

  103. Anonymous says:

    1) The behaviour of Dr Kerr is likely to damage Jane’s trust in the medical profession because Dr Kerr rushed the examination and didn’t take the time to listen and was dismissive of Jane’s concerns, which led to a misdiagnosis. This misdiagnosis led to Jane being in considerable pain for 11 days which could have been prevented if Dr Kerr had listened to Jane. Furthermore, Dr Kerr prescribed Jane a medication that gave her nausea and stomach pain because she was in a rush. This may lead to Jane not trusting future prescriptions given to her by other doctors. Dr Kerr behaved poorly in pretending not to see Jane and not apologising to her, which will further damage Jane.s trust in the medical profession as she might think doctors are not willing to confront and learn from their mistakes, so what is to stop something like this happening again?
    On the other hand, Dr Dee was hopefully able to improve Jane’s trust in the medical profession because she gave her an emergency appointment and listened to Jane. This led to a better diagnosis and a change in Jane’s medication. Despite this I still think that overall Jane’s trust in the medical profession will have been damaged by the situation, especially when Dr Kerr doesn’t try to make things right with Jane.

    2) Jane isn’t just upset about errors being made she is upset because she felt her examination was rushed and that her concerns were dismissed by Dr Kerr when the information she was providing could have led to a correct diagnosis. Jane is also upset because Dr Kerr didn’t try to talk to and apologise to Jane. If Dr Kerr had apologised and acknowledged her mistakes Jane might have felt better knowing that Dr Kerr recognised what she did wrong and that she could use these mistakes to improve her future practice.

    3) The Patient Safety breaches could have been avoided if Dr Kerr had taken more time with Jane’s examination and taken Jane’s concerns onboard when making the diagnosis. In addition, if Dr Kerr had not rushed through the alerts she would have seen that the NSAID medication was not appropriate for Jane so reading these alerts would have prevented this mistake.

  104. Anonymous says:

    1. It is not uncommon for doctors working in a pressurised environment such as the emergency department to carry out somewhat faster examinations. Unfortunately the underlying issue with Jane was missed by Dr Kerr and she felt that Dr Kerr was not interested in listening to her. This may have caused Jane to lose trust in the professionalism and knowledge of doctors, leading to her talking negatively about the NHS. However, I think it is important to remember that although effort is made to minimise errors, they do occur often in the healthcare because doctors are only human. The error made by Dr Kerr regarding the drug prescription could most definitely have been avoided and she should have apologised to Jane to recognise her mistake and reflect. This may have showed Jane that Dr Kerr was going to ensure to work so that similar mistakes do not happen in the future, restoring Jane’s trust. The GP’s consultation would have likely helped gain Jane’s trust and confidence in the health system as she was able to get the correct help.
    2. I think that the errors had a big impact on Jane’s feelings however the lack of apology and acknowledgement from Dr Kerr may have also made her feel more upset. Furthermore, because Jane had expressed the fact that she felt that the injury was worse than a sprain yet the doctor chose to ignore this would have cause a lot of upset, especially when Jane then learnt that she was correct about the injury being worse than what the doctor originally suspected.
    3. The patient safety breaches may have been avoided if the initial consultation was not as rushed because further examination may have enabled Dr Kerr to find the real underlying problem. Despite a lot of pressure and lack of time, examinations should not be rushed as it puts patient safety at high risk. Also, it is important to listen to the concerns of the patient as they are the best source of information for helping a doctor to diagnose. If Dr Kerr had of further examined Jane after she expressed her worries then maybe they would have got to the bottom of the problem there and then.

  105. Anonymous says:

    1. Both doctors handled their meetings with Jane very differently, however it must be noted that both doctors had a very different set of circumstances. Dr Kerr was very rushed and under extreme time pressures whereas Dr Dee had more time to do an in-depth examination. Despite this, it still does not excuse Dr Kerr’s mistakes. Dr Kerr appeared to be dismissive and rushed and made Jane feel as though her opinions weren’t listened to or valued. This understandably would make Jane frustrated and lose trust in the healthcare system. In contrast, Dr Dee took the time perform a more thorough examination and was able to conclude, that to determine the full extent of the injury an X ray was required. In addition, Dr Dee helped to alleviate Jane’s stomach pains, and was able to establish that it was the NSAID medication she has been taking that has aggravated her previous stomach ulcers . This was only discovered through Dr Dee listening to Jane and being so thorough. Jane’s experience with Dr Dee could have perhaps restored some of her trust in the healthcare system, and to not feel as let down.

    2. Understandably the errors that were made during Jane’s initial A&E visit would have made her upset. After that experience she would have already felt frustrated and dismissed. This was made worse by Jane’s condition deteriorating and the onset of stomach pains. However there are some other issues that would have made Jane more upset. The way that Dr Kerr handled herself after seeing Jane returning would have upset Jane further. As a doctor, we have a duty to be honest, and if Dr Kerr realised she did something wrong, she should have admitted it and went and apologised to Jane, reassuring her it wouldn’t happen again. This would have made Jane feel slightly more at ease knowing that her mistake had been recognised. Instead Dr Kerr ignored Jane and put off speaking to her, saying she was too busy, reinforcing the lack of trust in the profession.

    3. The most obvious way to avoid a patient safety breach was to have made the correct diagnosis in the first place. A patient safety breach occurred because of Dr Kerr’s rushed examination. Better communication between Dr Kerr and Jane perhaps could have avoided this, or even the opinions of other members within A&E to get a second opinion. In addition, patient safety was breached when the computer alert was ignored. While I understand that some of the time they are irrelevant, in this case it wasn’t and ignoring it has breached the patients safety, putting the patient at further risk of harm. In addition, perhaps a more thorough history taking would have uncovered these previous stomach ulcers from which the doctor could have made a decision not to prescribe Jane with that particular medication.

  106. Anonymous says:

    1. Dr. Kerr, due to assumptions based on past experience, ignores the contraindication alert when prescribing NSAID. Since this assumption results in Jane developing stomach pain, alongside ankle swelling, Jane is likely to be more sceptical of Dr. Kerr’s advice, possibly lowering her trust in the medical profession as a whole.
    However, due to Dr. Dee’s willingness to arrange an appointment as soon as possible, alongside their attentiveness, empathy and advice, it is likely that Jane would have ,at least to some degree, regained trust in the medical profession, perhaps realising that Dr. Kerr’s rash judgement is not representative of doctors as a whole.
    2. Whilst Jane would understandably be upset by her stomach pains and that her injury has progressed to the point where surgery is required – especially since it was entirely preventable – it is likely that most of her frustration stems from Dr. Kerr’s unwillingness to acknowledge her own errors and apologise directly to Jane.
    3.The most obvious and immediate way to prevent breaching patient safety is to give more consideration to contraindication alerts, even in situations where they are likely to be erroneous. Additionally, more time could have been spent during Dr. Kerr’s consultation to establish a more thorough report of the injury and take a more in-depth history from Jane. Finally, since unnecessary contraindication alerts appear to be common, perhaps further incidents such as this could be avoided by either improving the software which issues contraindications (perhaps not only issuing a generic warning, but also making the doctor aware of the likelihood and severity of potential adverse reactions) or by further educating and training doctors to pay more attention to contraindication alerts and reinforce the importance of taking them seriously.

  107. Anonymous says:

    1. Both of the doctors behaved very differently in this situation but this can partly be due to the different environments that they work in. Doctor Kerr works in a more chaotic environment which means the way he communicates with patients will be different than the way the GP does. Despite this, Dr Kerr did not communicate effectively or listen to the patients concerns. He rushed over her examination and ignored the patients pain and her previous experience of an ankle injury. In contrast, the GP was more attentive and took her previous history of stomach ulcers into consideration. Janes trust and general view of the medical profession could be altered. She may be less inclined to share her level of pain to the next doctor or feel like her opinion is invalid. The fact that Dr Kerr then prescribed the wrong medication will have furthered her lack of trust. It might deter her from sticking to future prescriptions which might evidently damage her health. Jane might put more trust in the GP doctors now as a result yet I would think she would all round be more cautious of the health care system as we tend to dwell more on a negative experience than of a positive one.

    2.I think a majority of the reason Jane is upset is because of the errors that were made as it now impacts her physical health. Yet Jane may be experiencing other feeling such as a lack of trust toward the health professionals and she may feel disrespected. I think Jane would be very upset by Dr Kerr ignoring her as it shows a lack of professionalism and also portrays dishonesty as if Dr Kerr is trying to head something. Jane may be filled with dear and dread at the thought of an operation as she now has to put trust back in other doctors and may feel reluctant to do so .

    3. The patient safety breaches could’ve been avoided in a number of different ways. First of there should be protocols put into place to ease the pressure of doctors in A&E to enable an extensive examination and to ensure that the doctor did not feel rushed and distracted. Dr Kerr should not have just based his assessment on his examination yet should’ve taken on board the patients concerns about her pain feeling different than before. Taking time to gather the appropriate information at this stage would’ve meant that an X ray would’ve been carried out and the injury caught earlier. Ignoring the NSAID drug alert was also a mistake and should not have been ignored.

  108. Anonymous says:

    1. Dr Kerr is an example of a doctor who made a few errors in terms of diagnosing and helping a patient which may have led to the patient no longer trusting the healthcare system or the doctors involved. Dr Kerr did not listen to the patient initially which led to misdiagnosis. As well as this she ignored the computer alert about the drugs being prescribed which led to the patient’s health deteriorating even more. However, Dr Dee is an example of a Doctor who listened to the patient and ensured the safety of the patient was a priority by taking her off the NSAID medication and following up with an X-ray in order to correctly diagnose Jane. Overall, the errors made by the initial doctor may have led to Jane no longer trusting doctors and feeling unsafe under the doctors watch.

    2. Not only were specific errors in terms of treatment made but Jane was not listened to from the offset and Dr Kerr assumed her diagnosis without further testing. Despite Jane explaining that she was in more pain than when she had sprained her ankle before, the doctor failed to follow through with an X-ray which led to her misdiagnosis. As well as this, Dr Kerr did not apologise to Jane despite knowing that she had made a mistake which had led to further harm and irritated stomach ulcers. This may had caused Jane to become more annoyed by her experience as the doctor did not recognise the mistakes she had made or assure to Jane that it would not happen again.

    3. In order to ensure that avoidable mistakes like these do not happen regularly, doctors should ensure that they do not rush any examinations with a patient despite being under extreme time pressure. The doctors should listen to the patients concerns as often this can help diagnose a patient correctly. As well as this doctors must not assume that the computer medication alerts are useless as it may flag up an important piece of information and help ensure the correct prescriptions are given.

  109. Anonymous says:

    1. The behaviour of the two doctors is very different. Dr Kerr conducted a very rushed and dismissive examination on Jane. She did not listen to Jane’s concerns and even ignored the computer system’s concerns with regards to Jane’s previous medical history of stomach ulcers when prescribing pain relief medication. This led to Jane’s ankle becoming much worse and her stomach becoming upset too. This would have drastically decreased Jane’s trust in the medical profession; as she left with a misdiagnosis. On the other hand, Dr Dee may have restored Jane’s faith in the profession as she listened to Jane’s concerns, correctly referred her to the X-ray department and gave her pain relief medication which did not irritate her stomach. This allowed Jane to feel more valued as a patient and also more satisfied as she is now getting the correct medical care that she requires.
    2. The errors that were made definitely had a large negative impact on Jane’s satisfaction with the medical profession. However, I think that the lack of apology from Dr Kerr to Jane is another reason why she felt so undervalued as a patient. Also the fact that she can no longer run for the foreseeable future due to her surgery was another major factor in why Jane was so upset.
    Having more doctors on the ward would have avoided the patient Safety breeches as Dr Kerr would not have had to be as rushed and dismissive of Jane’s concerns. Also, if Dr Kerr had not ignored the computer alert with regards to NSAIDS medication, Jane’s s nausea would have been avoided.

  110. Anonymous says:

    Dr Kerr dismissed jane’s views, rushed, misdiagnosed her, ignored the alert signal on her medication causing ulcers and then didn’t apologise, Dr Dee listened to Jane’s views, took her time, gave the correct diagnosis and new medication to stop the ulcers. this will undermine Jane’s trust in the profession because she cannot rely on being treated by a trustworthy Doctor.
    Jane is upset about getting the incorrect treatment and also that her concerns were not heard.
    Updating hospital guidelines to include the patients concerns, this way a quick examination is able to be used while also ensuring every single patient is being heard by every Doctor, not just brushed over when the Doctor is stressed

  111. Anonymous says:

    1. The difference in the behaviour of the two doctors who treated Jane may affect her trust of the medical profession in numerous ways. Dr. Kerr firstly performed a quick examination of Jane’s ankle which may have made Jane feel that the consultation was rushed and that she did not have a voice as Dr. Kerr was dismissive of Jane’s comments. The misdiagnosis of a sprain which was in fact a fracture may cause Jane to lose confidence in the healthcare professionals’ knowledge, although misdiagnosis is common. Furthermore, Dr. Kerr prescribed the wrong medication to Jane which caused her further problems and discomfort, which may have made Jane feel that more harm was being done than good. By Dr. Kerr withholding an apology, it could have indicated to Jane that Dr. Kerr was not remorseful of her actions and simply did not care about the impact her actions had on Jane.

    On the other hand, I feel that Dr. Dee partially restored Jane’s trust in the medical profession as she showed that she was listening to Jane’s concerns and was able to refer Jane to the hospital for further investigation, whilst partially relieving her discomfort by prescribing the correct medication.

    2. I feel there is a combination of factors causing Jane to be upset. Firstly, the misdiagnosis made and incorrectly prescribing medication to Jane caused her further pain and discomfort, possibly causing her to be upset. However, the manner in how Dr. Kerr has approached this situation and not apologising to Jane may make her feel that she is not being treated with respect and dignity, causing further upset.

    3. Patient safety breaches could have been avoided if Dr. Kerr had performed a more efficient examination and made the appropriate referral to the X – ray department or she could have asked a colleague for a second opinion. She also could have been more attentive to the computer alerts associated with the medication.

  112. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Dr Kerr’s actions would diminish the trust that Jane has in the medical profession, Her initial examination was not thorough enough and as a result Dr Kerr misdiagnosed Jane’s fracture as a sprain. Jane suffered at home unnecessarily not only because of her leg but also due to the NSAID medication that aggravated her stomach ulcers. Further to this Dr Kerr ignored Jane when she saw her a second time once she realized she had made these errors. This would make Jane feel uncomfortable and also possibly dehumanized as an apology would have been needed restore Jane’s trust in the medical profession. Dr Dee’s actions would increase Jane’s trust in the medical profession as she listened carefully to Jane’s story and sent her to get an x-ray which identified the fracture. She also knew about Jane’s stomach ulcers and prescribed an alternative pain medication. Jane would have felt listened to and cared for by Dr Dee’s actions.
    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    The errors that were made contributed to Jane being upset as she suffered unnecessarily for 11 days and as a result of going into hospital she came out worse due to the wrong medication being prescribed. However she would also be upset due to Dr Kerr’s actions when she saw her the second time. Being ignored by Dr Kerr left Jane confused and upset and would have made her feel worse. She is also a keen runner and due to the injury and the surgery she now needs on her leg she wont be able to run for a while. This would certainly lead to her sadness.
    3. Suggest how the Patient Safety breaches in the case could have been avoided
    The patient safety breaches could have been avoided if the initial examination had been more thorough and Jane’s worries had been taken into account. The notes about the NSAID medication should have been checked by multiple people to ensure the medication was safe for Jane to use. Jane could have been given the option to a second opinion if she wasn’t happy with the initial diagnosis.

  113. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Both of the doctors that Jane came in contact with will affect her level of trust in the medical profession differently. The A&E doctor who rushed through her examination of Jane’s ankle and was dismissive of Jane’s concerns may cause Jane’s trust in the medical profession, particularly her trust in hospitals, to decrease. Because Dr Kerr ignored Jane’s concerns, Jane may be less likely to voice her opinion in a consultation, damaging the doctor-patient relationship.The fact that Dr Kerr then went on to prescribe a pain medication that aggravated Jane’s peptic ulcer disease would have further damaged Janes’s trust in the profession. A full apology would have been needed to restore Jane’s trust however this was not offered by Dr Kerr. Some trust may have been restored by the G.P who thoroughly examined Jane and listened carefully to her concerns, leading to her being referred for an X-Ray. The GP also changed Jane’s prescription which helped settle her stomach. This may lead to Jane trusting primary care more than secondary care.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Part of the reason Jane is so upset would be because errors were made however I think if Dr. Kerr would have apologized to her she wouldnt have been so upset. I think it is the fact that Jane feels she has been let down by the hospital and instead of the hospital acknowledging this, it has been ignored. The fact that she has to get surgery and won’t be able to run again for a while would also be a contributing factor to her sadness.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    Dr Kerr could have taken more time with her examination and listen more to jane’s concerns. Because she was tired and stressed due to the long waiting list she could have asked for a second opinion on Jane’s ankle in case she was missing something. Another option for Dr. Kerr would have been to take a break when she felt the workload was becoming too much and causing her judgment to become impaired. A better computer system may also be needed, one that isn’t ignored so easily, to avoid other doctors making the same mistake when prescribing medication that was made in Jane’s case.

  114. Anonymous says:

    The behaviour of the two doctors is very different. Dr Kerr dismissed the patients concerns regarding her pain, and ignored the patients request regarding a potential x-ray. In addition, the A&E doctor prescribed a drug that Jane has adverse reactions to. Although the computer system failed, the doctor should have asked Jane if she had been on the medication before to double check. This approach ultimately lead to a wrong diagnosis of Jane’s condition. I believe this would damage the trust that Jane has in the medical profession, being more concerned with reducing the volume of patients in A&E than the quality of care provided. However, the GP doctor listened very carefully to Jane’s concerns starting from the beginning of the incident and was capable of treating Jane correctly. Jane may have more trust in her GP as she felt listened to and in the end was diagnosed correctly. Jane could possibly be upset by the way she was treated in A&E. She may have felt that her concerns were not listened to and that there was no doctor-patient relationship. Patient safety breaches could be avoided by spending more time on each patient, and being focused on the quality of care that you provide rather than the number of patients that have to be seen that day.

  115. Anonymous says:

    The difference in the behaviour of the 2 doctors may cause jane to lose a significant level of trust in the medical profession. Dr Kerr was very dismissive of Jane’s complaints and concerns, lazy for not taking time to read the medication warnings and showed no empathy to Jane. Furthermore, Dr Kerr seen her mistakes and chose not to take the opportunity to apologise showing she had little remorse for her actions and is unlikely to learn from her mistakes. On the other hand, Dr Dee listened very carefully and made a detailed examination allowing her to make the best diagnosis. Dr Dee placed janes health above the pressure of a busy waiting room. Both doctors were working in high pressure environment and handled it in completely different ways. Dr Kerr failed to improve janes condition and made it worse whereas Dr Dee ensured the most appropriate treatment was given. Jane will have been left with 2 very different impressions of the medical profession. She may feel that hospital staff are not well trained, inconsiderate of patients and only concerned about waiting times. She may also feel that staff in GP surgeries are very hard working and always try their best for patients. The whole process may have cause jane to lose significant trust in hospitals and place more trust in GP surgeries.
    Although errors are a significant factor in why jane is upset it is probably due to several other factors. Jane is likely upset because she felt she was not listened to in her first appointment, her concerns were dismissed and because Dr Kerr ignored the opportunity to apologise for the mistakes made.
    Patient safety breaches could have been avoided if several changes were made. Firstly, systems should be in place so doctors in accident and emergency are not under so much pressure and longer time slots should be given for each appointment. Also, the computer system should be reviewed, and staff trained not to ignore important warnings, perhaps a system involving different tiered risk warnings.

  116. Anonymous says:

    The behaviour of both doctors involved will affect the way that Jane views the medical profession in different ways. Dr Kerr’s behaviour will most likely make Jane have less trust in the medical profession. This is because Dr Kerr did not take Jane’s views on board and so she may feel like Dr Kerr did not have her best interests in mind. This could lead to Jane being less likely to voice her opinion to medical personnel in the future which is important when trying to come to the best outcome for the patient. Dr Kerr also provided Jane with the incorrect medication for her pain which could lead to her not taking future medications as she will no longer trust the opinion of the doctor. Dr Dee, on the other hand, made sure to listen to Jane’s story in full and conduct a thorough examination rather than the quick one carried out by Dr Kerr. Dr Dee also realised that the NSAID medication was most likely the cause of her stomach pain and so by changing Jane’s medication may have helped to restore some of Jane’s faith in the medication provided by doctors.
    Jane was upset for several reasons. No one likes it when an error is made and so this will be a contributing factor to how Jane feels. However, she may also feel let down by Dr Kerr for not apologising for the mistakes which she made to cause the error. In many circumstances people are a lot more accepting of mistakes when they are apologised to by the person who made the error. This also feeds into the idea of the duty of candour where doctors should be open and honest with their patients.
    The patient safety breaches could have been avoided by having more doctors on the ward in the original examination. This would have taken pressure off Dr Kerr to allow her to make a more thorough examination of Jane and so the correct treatment could have been provided. In addition to this, the computer system for the medication could have had a colour coded system to allow the doctor to see the severity of the warning before deciding whether to dismiss it. This would have made it more likely that the correct medication was given to Jane for her pain.

  117. Anonymous says:

    The difference in behaviour demonstrated between the two doctors highlights to Jane that, even in very busy scenarios, effective care can be delivered with care and patience. The failings of Dr. Kerr were many and numerous; the examination was rushed and dismissive of patient complaints, she misdiagnosed the fracture despite the patient’s previous experience, and due to further negligence, prescribed the wrong medication even though it was flagged, failings furthered by the unprofessional behaviour (avoidance and lack of apology). This all contributed to poor patient experience, and ultimately a likely loss of faith in the profession.
    Jane, as with many patients, is likely to understand wrong judgement as human, if reasoning and an apology is properly given in a way that they can understand. It was because of the manner of the first doctor, who, as Jane will feel, didn’t properly listen to her and actually has made her condition degrade due to a lack of care with the medication, and overly brief examination. If a patient doesn’t feel like they are being listened to, has been ignored and ‘brushed under the rug’, it is normal to feel disgruntled and upset, I believe it is this, more than anything, that is driving the complaint.
    The breach could have been avoided initially if Dr. Kerr had though of HALT procedure, ensured that she had taken due care and attention with her examination. If a doctor is feeling overwhelmed, support measures should be in place, and a team meeting can be taken, and the best course of action decided. The next major issue is the ignorance of the drug alert, something that could be vitally important – the normalcy of the ignorance of this alert suggests a leadership and department-wide failure.

  118. Anonymous says:

    1. I think the behaviour of Dr. Kerr may have caused Jane to lose a significant amount of faith in the medical profession. Dr. Kerr’s consultation with Jane was far too rushed, dismissive of Jane’s concerns and she ultimately failed to diagnose the fracture of Jane’s lower fibula. Due to further clinical negligence, incorrect medication was prescribed to Jane, leading to further problems for Jane in relation to her stomach, meaning the consultation caused more issues for Jane, rather than solving her initial one. The unprofessional behaviour of Dr. Kerr (no apology for her mistakes) when Jane returned to the hospital, would’ve certainly been upsetting and unsatisfying for Jane.

    However, the behaviour of Dr. Dee was in contrast to Dr. Kerr and probably helped restore some of Jane’s trust in the medical profession. Dr. Dee found the time to schedule an appointment for Jane and provided her with the help she initially wanted. She organised the x-ray and prescribed her alternative medication. The information was deduced through thorough examination and properly listening to Jane, something Dr. Kerr failed to do. Jane is most likely experiencing a mix of feelings in relation to her trust in the medical profession as she faced two very contrasting experiences in a short space of time.

    2. I think Jane is both upset and angry for a variety of reasons, apart from the fact that errors were made. I think she is upset that she wasn’t treated properly by Dr. Kerr during the consultation. The doctor dismissed Jane’s concerns and didn’t take the time to fully listen to Jane and properly diagnose her. I think she is upset and angry that she had to wait 11 days to have surgery for her fracture, an unnecessary amount of time. I think she is upset that this encounter has weakened her trust in doctors, a feeling no one wants to experience. She’s probably upset that although Dr Kerr saw her in the hospital the second time, she didn’t take the time to apologise for her mistakes which is highly unprofessional.

    3. The patient safety breaches could have been avoided if Dr. Kerr didn’t rush the initial consultation with Jane. She should’ve taken the time to listen to Jane’s words and realise that this was more serious than a sprain and that an x-ray was required. She shouldn’t have ignored the contraindication alert for NSAID, as this clearly suggested the bad effects the medication would have on Jane, it could’ve been easily avoided if she heeded the warning, rather than overlooking it.

  119. Anonymous says:

    1. Jane’s trust in the medical profession may be damaged due to the actions of Dr Kerr. Jane felt rushed and not listened to during the initial consultation and her concerns that were ignored by Dr Kerr were then proved right after the diagnosis 10 days later. Dr Kerr also prescribed medication which should not have been given to Jane. Hopefully Jane’s trust in the medical profession is restored thanks to the actions by Dr Dee. During the consultation at the GP, her concerns were listened to and an effort was made to reach the correct diagnosis.
    2. Not only would Jane have been upset by the several errors made when she would have been feeling scared and concerned, but also because as a result of those errors her unnecessary pain was prolonged and her injury could be worse off for it. Jane also would be upset that she wasn’t listened to. Moreover, Dr Kerr did not apologise for her errors when given the chance.
    3. At the initial consultation, had Dr Kerr followed the HALT protocol the misdiagnosis and prescription of NSAIDS causing the nausea most likely could have been avoided. A better system should be in place to point out contradiction alerts.

  120. Anonymous says:

    1) Jane would feel mixed emotions to her trust in the medical professions, on one hand she was dismissed by an A&E doctor after expressing her concern and requesting for more help therefore she would feel ignored and let down when her diagnosis confirmed her gut instinct was right. However, when Jane visited her GP her experience was the opposite and followed the exact behaviour a doctor should exhibit “listens carefully as Jane recounts the accident in full, particularly when she describes that she has never experienced pain of this magnitude before” This allowed the GP to get a full understanding of Janes situation and send her in the right direction to treatment in the most timely manner. Therefore, due to the contrasting approach by both doctors it could lead to jane having no trust in the medical profession after her A&E experience, she could have partial trust in GP practice and not the main hospital or she would still maintain full trust if she believes that the first incidence was just an accident.

    2) Jane could also be upset because she had to wait 11 days for her surgery that she lost her appetite and felt malnourished with low energy levels. She may feel upset by her lack of mobility and nausea or even just because she felt her voice wasn’t valued or heard by the hospital even when she expressed her concerns.

    3) If DR Kerr followed the H.A.L.T initiative and took the time to full listen to Jane then the mistake may have been avoided. If Dr Kerr did not ignore the computer alert that is there for a purpose then the nausea may have been avoided.

  121. Anonymous says:

    1) Jane’s visit to Dr Kerr was not a pleasant experience which could cause her to lose faith in the medical profession. She did not feel listened to, was rushed during her consultation and misdiagnosed by Dr Kerr. On Jane’s second visit to A&E, Dr Kerr could have apologised to Jane about her mistake but instead ignored her, again leaving Jane with a bad impression of the medical profession. Jane had a completely different experience with Dr Dee which may restore her faith in the medical profession. Jane felt listened to and despite being pushed for time, a thorough examination was still carried out. Furthermore, Dr Dee already had a good rapport with Jane since she had been to this doctor many times before. Also, Dr Dee sent Jane for an x-ray which ended up uncovering her actual problem, therefore Jane will have even more trust in this doctor for the future.
    2) Obviously, the errors that were made has caused Jane to be upset but there are other reasons too. Firstly, not only was Jane’s original injury misdiagnosed but she was prescribed medication that caused her harm in her stomach, leaving her with more problems after her first consultation than she originally came for. Also, Jane has endured 10 days of suffering which could’ve been significantly reduced and she now has to undergo surgery, something that may have been avoided if Dr Kerr had sent Jane for an x-ray. Furthermore, Dr Kerr never apologised to Jane about the mistake made, even when given the opportunity, and Jane may find this frustrating as she originally did tell the doctor she feared her injury was worse than what was assumed.
    3) The Patient Safety breaches could’ve been avoided if Dr Kerr originally spent a longer time with Jane in the consultation and listened to her without dismissing her concerns as this may have resulted in a referral for x-ray. Also, ignoring the contraindication alert from the computer is a major patient safety error and the fact that this is often done in the ED department shows that a different system should be implemented so that each warning is taken seriously.

  122. Anonymous says:

    1. The behaviour of the first doctor may damage the trust that Jane has in the medical profession. Jane may feel as if she has been let down by the medical profession due to the misdiagnosis of the first doctor. However the second doctor may reinforce the trust Jane has in the profession as the doctor was able to correct the diagnosis of Jane and prescribed Jane medication which eased the pain in her stomach.

    2. I believe Jane was angry, not just due to the mistakes that were made, but also because Jane’s concerns about her injury turned out to be true and they were initially dismissed by the doctor in A&E.

    3. The patient safety breaches could have been avoided by fully examining Jane’s legs, for example giving her an x-ray. Also if the doctor had checked to see if Jane’s stomach ulcers would have been disturbed by the NSAID medication.

  123. Anonymous says:

    I feel Jane’s trust in the profession will be affected as she has seen the contract between the two doctors involved in her care. The A&E doctor ignored her concerns while her own GP knew her well enough to listen closely when she described never feeling that magnitude of pain before. Dr Kerr in the A&E also ignored the warning signs of the medication and due to this Jane has experienced more pain, and this experience will have likely damaged her trust in the medical profession as it is clear that her safety and protection was not at the centre of the doctors decision. Both of the environments that Jane was seen as a patient in were rushed and busy, yet her GP took time to listen and check that the correct referrals were done to the hospital, whereas Jane left the A&E feeling that her consultation was rushed and due to a wrong diagnosis, she now has to undergo surgery which will further distrust her life. This can also damage her faith in the medical profession.

    I feel that while Jane is upset due to the medical errors made that are leading her to have an operation and an upset stomach, there is likely more to the story that made her feel this way. The Doctor’s unwillingness to acknowledge her mistakes and apologise for her medical errors will most likely make Jane feel like she is being further ignored and feel upset that she is not being treated with respect as a patient. I feel like she may also be upset as the prospect of surgery could have maybe been avoided if she had been correctly diagnosed and now her injury will disrupt her life to a much greater degree.

    I feel like patient safety errors could’ve been avoided by the A&E doctor giving Jane a full consultation after listening to her concerns of pain. Despite the busy environment, if the other A&E were able to support the doctor and take some of the pressure off then the chance of error may have been reduced. Ignoring the drug warnings on the system was a major error, and this could perhaps be improved with a change to the system, so that the ‘minor and insignificant’ things that the system flags up do don’t cause the major issues to go unnoticed.

  124. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Jane’s trust in the medical profession may be reduced by Dr Kerr. However Janes own GP would know her a lot better and aware of he prev PMH. Janes trust in this Dr will have increased as she has sent her to get an xray and confirm her final diagnosis.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    No Jane may also be upset due to the lack of apology, waiting times and being ignored by Dr Kerr. Jane also expressed concerns herself that she thought it was broken however these were ignored previously.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    Dr Kerr could have spent adequate time on the consultation and listens to pts concerns regarding the fracture. This ay have resulted in a appropriately timed referral for an xray. Dr Kerr should alos not have ignored the computers warning without first checking the meds and pts PMH.

  125. Anonymous says:

    1. The behaviour of the A&E doctor and GP are very different in this situation.
    The differences are due to the contrast of a hospital and general practice environment and also how Jane was treated as a patient.
    The GP already knows Jane quite well. This sets up a good rapport at the beginning of the consultation. His willingness to listen to Jane’s concerns, the more in-depth examination and a referral for an x-ray, will have reinforced the trust she has in her GP. She may now feel much more comfortable approaching her GP with issues than attending A&E in the future.
    The realisation at the hospital that her injury was, in fact, more serious than previously diagnosed will have left Jane feeling let down by the doctor who initially treated her. This along with the fact she had attempted to express her concerns about her injury at the time of the first consultation, and was dismissed, will have reduced the trust she has in the department.
    Additionally, the error made by the A&E doctor when prescribing Jane’s medication exacerbated a previous illness and caused her more pain. As a result, she may be reluctant to take medication prescribed to her by a doctor in A&E in the future.

    2. The errors made during Jane’s care have contributed to her being upset. She was dismissed by the A&E doctor when she felt her injury was more serious and the misdiagnosis resulted in the injury getting worse. This could impact how it heals and affect Jane’s life negatively in the long-term. Furthermore, the medication prescribed by the doctor caused her more pain and her injury means she won’t be able to continue her hobby of running for some time.
    I think she is also upset because Dr Kerr does not approach her to discuss the errors that were made and offer an apology for how they impacted her. Often, where a medical error has occurred, the patient and family simply want an apology and recognition of the distress they have experienced. For patients like Jane, an apology and reassurance that measures will be put in place to prevent the same mistakes being made again could help regain her trust in the department.

    3. The patient safety breaches, in this case, could have been avoided.
    Error messages appeared on the computer to Dr Kerr when she was prescribing Jane the medication. As the doctor was under pressure in the busy A&E, they rushed through the messages resulting in the error. Even when under pressure, doctors must always put the care of the patient first and must not let stress compromise patient safety.
    The fact doctors in the department often skip through these messages highlights an area where some training may be required. An emphasis that these notifications are very important in maintaining patient safety will reduce incidences like Jane’s. Her case could be used as an example to highlight the importance of reading these messages.
    The error made by the doctor in the initial diagnosis could also have been avoided. If she had taken some extra time to carry out a more in-depth examination, the fracture may not have been missed. Jane could have had an x-ray on the day she first arrived at A&E and received treatment much faster.

  126. Anonymous says:

    1.The actions of the two doctors are in stark contrast with one another. One takes time to evaluate the situation and the patients concerns and act upon them. This a positive experience for Jane as she feels she is being listened to. On the contrary the original emergency doctor had quite the opposite effect as they left a bad impression of the health service in the eyes of Jane due to the rushed and ultimately incorrect examination
    2. The errors certainly play a part in Jane’s reasoning for wanting to complain, however the main reason will be due to how the doctor came across during the brief consultation. The abruptness of the examination would have seemed rushed and Jane would not have felt listened to nor her concerns met. It is vital that the doctor listens to the patients concerns as the doctor will not always know everything and the patient’s opinion will always form a helpful impact when making a diagnosis.
    3. If the original consultation was not rushed then the errors would not have occurred. Furthermore the lack of care when prescribing the medication and not reading all the information provided led to more patient safety breaches occurring.

  127. Anonymous says:

    The two doctors deal with Jane in a very different manner, one gives her a rushed diagnosis and doesn’t really address her views and worries, while the other listens fully to what Jane has to say and acts on their opinion but also on Jane’s views. This is notable when Jane states that she has never had pain like this before. Dr. Dee’s actions leads to a correct diagnosis, therefore disproving Dr. Kerr’s original diagnosis. This may result in Jane’s trust in Dr Kerr being diminished, as not only did she rush the consultation and not take on Jane’s concerns she ultimately got it wrong. This could mean that Jane would be unsure of whether to trust any future decisions made by Dr. Kerr. Further emphasised when Jane sees Dr. Kerr, but she does not acknowledge Jane- which may be perceived as arrogance.
    Jane is upset as her concerns were ignored, meaning she has to go for surgery 11 days after her incident and that she was given medication that upset her stomach- something a doctor should have checked. The fact that errors were made would obviously be upsetting as it has caused Jane a great deal of pain and inconvenience, however this could be made worse by the fact that the doctor who made the original mistakes seems to show no remorse to Jane, does not apologise or acknowledge her wrong doing and therefore offers no assurance that the same mistake won’t happen again. Furthermore, the fact that the also busy GP was able to take time for Jane and ultimately lead to a solution may emphasise that this mistake should not have happened in the first place.
    The Patient Safety breaches in this case could have been avoided if in the original consultation, Dr. Kerr had taken the time the listen to Jane’s concerns and value her opinion- especially when she had previously sprained her ankle and stated that this was worse. In the long run, doing this and taking her for X-Ray would have taken up less time as she would not have had to come back to hospital. In addition, had the doctor checked that the medications suitable, then further pain and issues could have been avoided. Patient Safety issues can happen easily under pressurised condition such as an emergency department, and therefore it is essential that doctors should stop and consider the risk to patients and implement possible measures to reduce that risk.

  128. Anonymous says:

    1. Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    Dr Kerr dismissed Jane’s condition whereas Dr Dee would have listened to the whole story in order to take follow up steps. Dr Kerr rushed the consultation but Dr Dee would have the luxury of a full consultation session that he has booked, therefore he may have been more relaxed. Dr Kerr ignored the warning signs but Dr Dee considered her medical history before taking further action. Dr Kerr was hopeful for a good outcome but Dr Dee took more proactive steps to her situations. Ultimately the doctors saw different stages of the deterioration of her ankle and her well being so it difficult to compare fairly.

    2. Is it just because errors were made or are there other reasons why Jane is so upset?
    Jane would mostly be upset that her condition isn’t improving. She may not be aware of the errors.

    3. Suggest how the Patient Safety breaches in the case could have been avoided
    If Dr Kerr took more care in his prescription, history taking and listening to what Jane had to say the situation would not have deteriorated to this level.

  129. Anonymous says:

    The behaviour of each doctor contradicts one another. Dr Kerr rushed through Jane’s first examination, missing out vital information regarding her medical history. When Jane returned to the A&E Department Dr Kerr refused to acknowledge her and apologise. Dr Dee, however, took the time to listen to Jane’s concerns, recognised the problem with the NSAID medication and acted appropriately. This inconsistency may cause Jane to have a lack of faith in the healthcare system.

    Jane is upset because her concerns were not addressed and she may feel unimportant and ignored. This may also be largely due to the errors that were made and the way in which they were carried out, without taking Jane’s personal opinion into consideration.

    Patient safety breaches could have been avoided if Dr Kerr had taken the time to carry out Jane’s consultation thoroughly, by listening and taking her concerns into consideration. In addition, the ignoring of the alert regarding NSAID had a critical role in the Patient safety breaches that occurred.

  130. Anonymous says:

    1.Jane’s experience with her GP will have a positive impact on her trust of the medical profession. The genuine concern and effort from the GP to listen to her concerns and act accordingly will have made Jane feel cared for and increase patient satisfaction. Her experience with Dr Kerr will have made Jane question her trust in the profession at first. When Jane attended A&E again, Dr Kerr’s opportunity to redeem her rapport with the patient was voluntarily avoided. This will have definitely had a negative impact on Jane’s trust of the medical profession.

    2. Is it just because errors were made or are there other reasons why Jane is so upset? Jane as a patient was made to feel unimportant and her concerns were not listened to at first. This may have made her feel embarrassed and upset as though the doctor didn’t believe her or think her opinion is respected. The missed opportunity for an apology may have upset her as such a simple gesture would have shown professionalism and enough concern for Jane to feel valued by that doctor again.

    3. Suggest how the Patient Safety breaches in the case could have been avoided. Appropriate time allocated to more thorough examination and diagnosis. Less carelessness over the prescription of the medication – paying attention to patient medical history and treating the patient as an individual. Better reflective practice and focus on professionalism – Dr Kerr should have reflected on the initial mistakes and apologised to the patient.

  131. Anonymous says:

    1. I think that janes trust in her GP may have been improved as the doctor listened to her and followed through with a detailed examination whereas the hospital doctor did not seem to listen to janes concerns and seemed to brush them aside when Jane explained she thought it was more than a sprain. This could have changed how she approaches A&E in the future and may have lowered her trust in the department.
    2. I don’t think that the mistakes are the only reason Jane is upset, I think she is upset as no one realised or owned up to the the fact that mistakes where made and I think she is annoyed that her feelings and pain weren’t acknowledged which impacted her life for the next while (such as not being able to walk the stairs)
    3. Patient safety breaches could have been avoided if the a&e doctor listened to Jane and took her thoughts into consideration before rushing her out and also if they had of properly read the patients history and not ignored the alert on the computer.

  132. Anonymous says:

    Dr Kerr’s behaviour would have definitely influenced Janes opinion of the medical profession. Dr Kerr was dismissive of Jane’s concerns that her injury was more than an ankle sprain. Dr Kerr also only spent a limited time with Jane, rushing through her examination, perhaps leaving Jane with the impression that she didn’t care. Furthermore, Dr. Kerr pretending not to notice Jane in the A&E would have made Jane feel worse. However, Dr Dee’s approach to Jane’s injury was very different. He listened carefully and spent time performing a thorough examination on Jane. This may therefore restore Jane’s faith in the medical profession.
    Jane would have been frustrated with errors made in the initial diagnosis, however what worsens it was the fact that Dr Kerr did not listen to Jane when she expressed concern that her injury was more than a sprain and in the end it turned out to be a fracture. In addition, the medication prescribed caused Jane additional discomfort. Also, instead of her ankle healing, her conditioned worsened.
    If Dr Kerr had taken more time to properly assess Janes condition and listened to Jane’s concerns maybe a misdiagnosis could have been avoided. Additionally, doctors should either not click through alerts, in case they miss any important information or the system should be redesigned so as to single out important alerts such as a patients reaction to a certain medication

  133. Anonymous says:

    1. The behaviour of the A&E doctor will likely have reduced Jane’s trust in the medical profession. The doctor was so rushed that she dismissed Jane’s concerns and did not give her any say over her own treatment (eg by ignoring her requests for an X-Ray). The A&E doctor also did not read Jane’s notes correctly which led to her being prescribed medication which ultimately caused her more pain by upsetting her stomach. Her experience with this doctor may make Jane less likely to present to A&E again as she may feel that they are too busy to treat her properly. However, Jane’s GP was very efficient and thorough in talking through her symptoms and arranging an X-Ray. Her experience with this doctor, who was competent and open to listen to her concerns, will have increased Jane’s trust in the medical profession.

    2. While the errors obviously caused Jane a lot of inconvenience and unnecessary pain and stress (nausea, sore stomach and a much more swollen and painful ankle), she is probably also upset about the way in which the A&E doctor communicated with her. She will likely be upset and frustrated that the doctor dismissed her concerns over the ankle being more serious than a sprain. She has also not been given an apology and is probably upset that the doctors have not yet acknowledged that mistakes were made.

    3. Patient safety breaches could have been avoided if the A&E doctor has asked Jane if she had any intolerances to medication or any previous symptoms with the medicine she had been prescribed, allowing Jane the opportunity to explain about her history of stomach ulcers and so the stomach pain could have been avoided. If the A&E doctor had not been under so much pressure (for example if more staff had been available or tasks had been shared out more evenly between the team) , she may have had more time to listen to Jane’s concerns, carry out an X-Ray and avoid a misdiagnosis. If Dr Kerr had then apologised to Jane and shared her mistakes with the hospital team, future breaches of patient safety could have been avoided.

  134. Anonymous says:

    Jane’s treatment by Dr Kerr is likely to have lowered her trust in the medical profession as she was adamant her injury was more than a sprain, but the doctor did not listen to her concerns. This doctor also prescribed medication which worsened her condition by causing stomach problems, which should not have happened if the doctor had properly read the medical history. Contrasting this, Dr Dee is likely to have increased her trust in the profession (perhaps not to the original level) as they listened to Jane and took time in changing the medication and arranging for an X-ray to be taken and a proper diagnosis made, which Jane wanted in the first place.

    Jane is upset as her medical condition was worsened by the mis-diagnosis of her broken ankle and the fact she was given a prescription for drugs which caused her to have stomach pain as well as the broken and painful ankle. The inconvenience (not being able to climb the stairs) and pain it caused her would also contribute to her upset.

    The A&E doctor properly listening to Jane in the first instance when she came in with the sprained ankle. Despite the busy working environment, patients still deserve the attention of the medical professional treating them. The breaches could also have been avoided if Jane’s history had been properly considered – especially when the warning flashed up for the NSAIDs which could have avoided her stomach pain.

  135. Anonymous says:

    1. Jane’s trust in her GP may not have been impacted, or could even have improved, as the GP care was exemplary. After X-ray, communication from x-ray to GP and speed of referral to A&E were timely. It is likely that the GP’s previous encounters with Jane played a role in this. The GP would have taken into consideration Jane’s opinion of the injury along with her history based on previous GP attendances. In contrast, Dr Kerr is unlikely to have met Jane before and did not recornise the significance of Jane’s knowledge of her pain threshold. This is likely to have impacted on Jane’s trust towards all ED doctors and potentially make her more wary of new doctors she hasn’t met before. Hopefully her trust in her GP remained.
    2. Jane is likely to feel upset from a multitude of reasons. The injury in itself, along with the requirement for surgery and the potential lengthy rehabilitation could make Jane feel upset as she is an avid runner. Post-operative implications could greatly impact on Jane’s day-to-day life, especially as she would be unable to run. Running could be a significant part of her daily/weekly routine that brings benefits for physical health – considering she is a type 1 diabetic – and mental health. Additionally, NSAIDs may have indirectly impacted on her diabetic control as she lost her appetite. Jane could understandably feel frustrated that she was not listened to by the A&E department, regardless of any outcome. Jane was patient and reasonable with all staff at A&E, but this was to no avail – arguably her patience proved a disadvantage. Therefore a range of physical and emotional reasons could account for Jane feeling upset, not just the fact an error was made.
    3. Potential ways to have avoided Patient Safety breaches would include: recognition by senior medical staff that Dr Kerr’s work load was potentially excessive and adequate safety netting put in place, perhaps other staff such as those who triaged on arrival, could have recommend X-ray, or, could have raised any concerns on the patients behalf regarding inability to weight bear; recognition by Dr Kerr, or other A&E staff involved, that risk of X-ray radiation did not outweigh the risk of misdiagnosis given her pain levels and inability to weight bear; increased awareness by A&E staff that those who shout loudest are not necessarily those in greatest need – and vice versa. Additionally, this raises the issue of overuse of warning alert systems can cause ‘immunity’ or ‘blindness’ to staff as over time the warnings are automatically disregarded without acknowledgement.

  136. Anonymous says:

    1. Being treated differently by the doctors might lead Jane to distrust the healthcare system and be reluctant to share information as she could perceive that some healthcare workers will not listen to her, and overlook her view. Alternatively this incident may lead Jane to be firmer in sharing her views in consultations to make sure the healthcare worker has heard here.
    2. Jane could also be upset that the injury is more serious than initially diagnosed.
    3. The initial consultation could have been more thorough and the the doctor could have made sure the patient’s concerns were listened to and addressed. Additionally, the healthcare workers could have explained the possible side effects of the medication to warn Jane of a possible upset stomach.

  137. Anonymous says:

    Dr Kerr’s actions are likely to cause Jane to feel clinically neglected and that her physical and mental well-being was dismissed. The fact that she was prescribed NSAID when she has a history of stomach ulcers will cause Jane to doubt any further medical opinion. Furthermore, she may postpone medical advice in the future which could have serious short and long term detrimental consequences on both her and her family.
    In contrast, Dr Dee listens to Jane which will allow Jane to feel respected. Nevertheless, the differing medical opinions may cause Jane to question which professionals advice she should take and who she can trust in the future.

    Jane is upset because errors have been made. More importantly, she is upset because she feels that her concerns were dismissed. Furthermore, she may feel that Dr Kerr has failed to treat her has a person and is merely treating the physical signs of illness. An employment of the biopsychosocial model would allow Jane to feel cared for as an individual and develop a patient-centred approach whereby she feels in control of her treatment.

    Patient safety breaches could have been mitigated if protocols were employed and that the contraindication alert was listened to and followed. Perhaps, the importance of contraindication alerts needs reinforced to ensure that they are appropriately managed.
    Additionally, a culture that allows staff to feel that they can report concerns and share safety lessons is vital to encourage an environment whereby improvements are consistently made.
    Dr Kerr should have felt able to apologise to Jane to reduce the impact to the Doctor-patient relationship. This is also an important moment of reflection for Dr Kerr as she can ensure that she does not repeat the same mistakes.

  138. Anonymous says:

    The behaviour of the A and E consultant (Dr. Kerr) would minimise Jane’s trust in the medical profession for several reasons; the A and E consultant ignored Jane’s opinion, especially when she was concerned about the severity of the instance, and so Jane would feel inferior; Jane was prescribed the incorrect medication, despite the doctor being alerted of its danger, and so she would feel her safety is not at the heart of medical decisions; and Dr. Kerr’s inability to own up to and apologise for her actions would portray the medical profession in an untrustworthy and dishonest manner. However, there were situations which would have restored Jane’s trust in the medical profession, particularly the interest of the GP to relive her pain and have a full, accurate diagnosis of her injury.

    The medical errors alone were not repsonsible for Jane’s mistrust of healthcare professionals. It was the dishonesty of the doctor in failing to admit poor clinical pratice and show enthusiasm to better her provision of healthcare. Patient safety and opinion was not at the centre of the medical procedures and so she may feel that she was disrespected by Dr. Kerr.

    Patient safety breaches could have been prevented by; the doctor in A and E taking time to focus fully on Jane and conduct a purposeful examination and treatment; the dcotor listening to the views and hints from the patient; support from other healthcare workers to aid the doctor in her work to relive stress; taking note of the alerts provided in relation to treatment drugs and preventing adverse effects; and not using guidelines as ‘law’ – using personal judgement.

  139. Anonymous says:

    For the first doctor they could have ruined jane’s trust by not being empathetic and understanding of her pain and situation whereas her GP was kind and listened to what jane was saying resulting in her giving a correct diagnosis.
    Jane is also upset due to the first doctors way of treating her and the fact that she hasn’t apologised
    They could have been avoided if the first doctor had been more attentive and empathetic towards jane’s feelings and the pain she was in

  140. Anonymous says:

    1. Dr Kerr’s behaviour will undoubtedly have had a negative impact on Jane’s trust of the medical profession. She was rushed and did not fully listen to Jane’s concerns furthermore she did not include her as a partner in her diagnosis and treatment. Moreover, it was proven that Dr Kerr made mistakes that could possibly have been prevented if she had taken more time with Jane in the first consultation. However, in contrast to this Dr Dee will have given Jane a positive outlook on the medical profession. Dr Dee listen carefully to Jane’s problems and performed a more thorough examination of her ankle. On top of this, Dr Dee took notice of Jane’s previous medical history regarding the NSAID medication thus showing an appropriate level of care, a level which was not displayed by Dr Kerr.
    2. The errors will no doubt be part of the reason as to why Jane is so upset as she had to suffer unnecessarily and was in a lot of physical pain, all of which could have been prevented. However, she may also be upset due to how she was treated by Dr Kerr from an emotional standpoint. Dr Kerr disregarded Jane’s feelings and opinions and like I mentioned previously, she did not include her as a partner in her diagnosis, she only viewed her as ‘just another patient’ in a busy schedule.
    3. The main way in which this case could have been avoided is if Dr Kerr took more time and had more patience during the consultation with Jane. However, this is easier said than done in a busy and stressful environment. So there are a number of practical steps that can be taken to ensure this does not happen again. There could be better management of time within the ward i.e. spending more time on patients that need it (as there was an extremely long waiting time). Furthermore personal reflection could be undertaken by Dr Kerr to look back on her mistakes so she is more aware of when she is becoming pressurised and stressed in the future, and therefore reminding herself that she should treat each patient with care and not rush any consultations.

  141. Anonymous says:

    Naturally the behaviour and errors made by doctor Kerr will leave Jane feeling upset, angry, and disappointed in the medical profession as a whole as Dr Kerr was its representative to her in that situation. In A&E Janes concerns were simply brushed aside and deemed unimportant by a doctor who could not empathise with her. The busy department that night caused Dr Kerr to simply panic in the moment and caused her to get patients out the door as fast as possible and not always actually treating the injury’s and illnesses presented. This may cause Jane to be hesitant in future to go to this A&E department and to trust the profession less. In contrast Dr Dee may have rebuilt some of this trust for Jane as she adequately set aside enough time to listen to and exam Jane and make a more accurate diagnosis. Her responses were relevant to Janes concerns and not what she assumed.
    Jane would have become even more upset after Dr Kerr did not apologise for the mistake made. A simple recognition of the mistake would have boosted Janes confidence in the healthcare system. Also in noting Dr Kerr looking at Janes notes for the second time, it is interesting to note she had time to look at the notes but not to apologise to Jane.
    In this instance if Dr Kerr had spent more time in listening to Jane in the initial consultation unnecessary pain could have been avoided. Despite being busy, this has now created more work and resources to be dedicated to Jane across the system. If Dr Kerr had read the warnings on the system in relation to her medication, Jane would not have been in such great levels of pain.

  142. Anonymous says:

    The actions of Dr Kerr will no doubt have undermined Jane’s faith in the medical profession. During her visit in A&E she was made to feel like she was not a priority and that her consultation was being rushed. Her concerns were also overlooked, perhaps undermining her trust in the doctor-patient relationship and dissuading her from bringing any concerns to a doctor in the future. Dr Kerr could have won some of this trust back by owning up to her mistake and apologising, and promising to do better. This could have also reduced a little of the bad feeling which Jane may now feel towards Dr Kerr. By contrast, despite the fact that the practice was busy Dr Dee took the time to listen to Jane’s concerns and act accordingly. The interaction with Dr Kerr will likely be the one which sticks with Jane though and it may put her off visiting A&E with urgent concerns in the future- she may instead choose to visit her GP where she felt her concerns were heard in this instance.
    I think Jane is obviously upset because the errors made have resulted in her suffering from severe pain for 10 days, and have resulted in her needing surgery, as well as exacerbating another stomach problem. However she is probably also upset because most or all of this could have been avoided if the doctor had listened to her initial concerns, this may lead her to feel like she does not really have a say in her own care.
    Patient safety breaches such as sending Jane home with an undiagnosed fracture could have been avoided if the doctor had listened to Jane’s concerns and ordered an X-ray as a precaution, although it can be understood that Dr Kerr was likely trying to adhere to A&E protocol. Dr Kerr should also have taken the time to acknowledge the drug alert as although they may often flag minor issues, when dealing with real patients it is always better to check and be safe- this would have prevented Jane’s further suffering from stomach ulcers.

  143. Anonymous says:

    1: After her experience in the Emergency Department (ED), it is likely Jane’s trust in the medical profession has been negatively affected. Dr Kerr’s rushed examination left Jane feeling as if her problems were not properly addressed, and she may not trust Dr Kerr to have gained enough information to make a diagnosis in such a short amount of time. As Jane’s symptoms are worsening as time passes and the medication she has been prescribed seems to be making her sick, it is likely Jane feels worried and confused – the condition she has been left in after her ED visit could contribute to further mistrust of doctors, as she does not seem to be getting better. In contrast, we are told that Jane has a positive experience with her GP, Dr Dee, who knows Jane well. Although the GP surgery is busy, Dr Dee takes the time to listen to Jane’s story of her fall, performs a thorough examination of her injured ankle, and acknowledges her concerns that the pain is worse than any she has felt before – a completely different experience than the one Jane had in the ED. This visit could improve Jane’s view of the medical profession, showing her that despite how busy a doctor is, they can still have the time to carry out a detailed examination of a patient and discuss any worries a patient may have. However, the contradictory advice she has received from the two doctors may have confused Jane further, leaving her unsure who to trust – although she has had a positive experience with her GP, her trust in the medical profession as a whole may have ultimately been damaged further. Furthermore, upon Jane’s second hospital visit to receive an x-ray, she may have noticed Dr Kerr pretending that she has not noticed Jane, which may leave her with the opinion that doctors are dishonest and do not want to admit fault.

    2: Before attending her GP appointment, it is possible Jane did not know for sure that an error had occurred in the diagnosis and treatment of her injured ankle, as she may have trusted Dr Kerr to have made the correct decisions. As mentioned previously, we are told her symptoms have worsened over time – although Jane may have believed a blatant error in diagnosis had been made, she could have just thought that perhaps Dr Kerr had failed to properly explain the side-effects of taking the pain medication to her or how her ankle would heal. Therefore, Jane could have been upset over a perceived lack of communication. Despite what she may have thought, it is clear Jane was distressed by the prolonged pain she was experiencing, and may have been afraid of the possibility her condition would continue to get worse. After finding out her ankle was in fact broken, she likely felt angry at Dr Kerr for the error, and upset at finding out that her worries were justified, and the pain she had been experiencing was avoidable. If Jane noticed Dr Kerr ignoring her during her second visit, this could have upset Jane even further. If Dr Kerr had acknowledged her role in inadvertently prolonging Jane’s pain, and apologised for her actions, Jane may have appreciated her courage in admitting fault – some of Jane’s negative emotions regarding her situation may even have been alleviated by an apology.

    3: If Dr Kerr had taken the time to more thoroughly examine Jane’s ankle and had listened to Jane’s concerns that the pain was far worse than what she had previously experienced, a misdiagnosis could have been avoided. However, spending long amounts of time with a single patient may not be possible in a busy ED – if Dr Kerr felt stressed or distracted, it may have been a good idea to ask for a colleague’s help in examining Jane, or in assisting in examining some other patients to allow Dr Kerr to check over Jane’s ankle again. It also appears that Dr Kerr has got into a habit of ignoring contraindication alerts – this is a potentially dangerous action, and these alerts should never have been ignored. An improvement to the system could be made to avoid doctors ignoring alerts – for example, it could be made more streamlined to avoid unnecessary alerts, or it could be altered so that in order for an alert to be closed, it must have already been read and acknowledged by the user.

  144. Anonymous says:

    1. The behaviour of the two doctors was completely different, the doctor in the hospital may have made Jane feel as though she was overlooked and that her treatment was not a priority. Whereas on the other hand the treatment in primary care Jane underwent detailed treatment and examinations which resulted in a reduction in her overall pain and also a solution. This ultimately may result in a reluctancy for Jane to attend the hospital and further for Jane to attend the GP when she requires any treatment.
    2. Jane is upset that not only that her pain and the severity of it was overlooked, but further that she was dismissed by the doctor. She was not given the detailed examination that was required and therefore Jane may find it difficult to trust her doctor again as she was not given the respect and attention that she needed. An apology would’ve given Jane a sense of understanding that a human error occurred, but as she did not receive an apology she may find it uneasy to return to secondary care.
    3. Patient Safety was breached due to the care provided by Dr Kerr, this is due to the stress of Dr Kerr making him rush the consultation with Jane resulting in a lack of communication and further listening of the extent of the pain that was felt by the patient. If Dr Kerr listened more carefully this may have resulted in the fracture being identified at an earlier stage of care and Jane having to endure a lesser extent of pain. Further if careful time and consideration was taken when using the computer system this would not have resulted in the alert being ignored and a further breach of patient safety would not have occurred.

  145. Anonymous says:

    The two doctors had acted quite oppositely , however there is a tendency for Jane to be more affected by Dr Kerr than her GP and therefore this could imply that Jane might loose trust in any other future doctor she might come across . Additionally , chances are that she might be hesitant to go to a GP or a doctor in the future , which could make her condition worse . Jane is evidently hurt about the mistake that was made , however it could be said that she is perhaps more affected by DR Kerr ‘s ignorance to her , despite the fact that the doctor had made a serious mistake and has failed to say sorry to her for that .Patient safety breaches could have been avoided by diligently looking into drug alerts even if they look trivial .

  146. Anonymous says:

    Obviously, Jane’s experience in A&E would have left her with an overwhelmingly negative perception of the medical profession. The doctor in A&E rushed with Jane and ultimately this led to misdiagnosis and a long and painful 11 days before she sought help from her GP. Given the pain she would have been in, this experience would have left its mark badly on Jane. This was exasperated by the incorrect prescribing of anti-inflammatories due to ignoring a warning on the computer. The pain felt by Jane in this sense due to a flair up in her stomach ulcers was also something she associated with the A&E doctor. Her experience with the GP was much more positive and would have instilled more faith in the profession. Knowing Jane, Dr Dee was aware of her problems with ulcers and took her off the NSAIDs which alleviated her pain in this regard but also took time to examine her and send her for an xray which ultimately led to a correct diagnosis.
    Errors played a big part in Jane being annoyed and upset however the delay in her treatment seems to have been annoying her. The error in the orginal diagnosis was the cause of this.
    Improving the workplace culture where prescribing errors flagged on the computer are routinely ignored would make it less likely the NSAID prescription would have been given to Jane. Also, ensuring staffing levels are adequate to allow enough time for doctors to properly examine their patients, especially in the A&E environment would have perhaps helped to ensure the proper diagnosis first time around and therefore both Jane’s pain and her dissatisfaction at the delay in receiving appropriate treatment may have been avoided.

  147. Anonymous says:

    The behaviour of Dr Kerr may compromise Jane’s trust of the medical profession due to the error in judgement that the doctor made; patients tend to expect doctors to be able to provide the correct diagnosis and treatment for their condition. In addition, Dr Kerr’s actions did not improve Jane’s condition and in fact made Jane’s situation worse by prescribing NSAIDs which led to Jane redeveloping stomach ulcers. Dr Kerr’s failure to listen to Jane’s concerns and then not apologising for the errors made may have made Jane feel unvalued and may cause Jane to not have trust in doctors. This may consequently lead to Jane avoiding accessing healthcare services in the future. In contrast, Dr Dee’s actions may have regained Jane’s trust by listening to her carefully, taking time to perform a thorough examination and arranging an X-ray to investigate the injury further. Also, Dr Dee was able to put right the prescribing error made by Dr Kerr by telling Jane to stop taking the NSAIDs and prescribing an alternative pain medication. Dr Dee also tried to reverse the negative effects caused by the NSAIDs, which may lead to Jane’s stomach symptoms disappearing and her regaining her health.
    Jane is primarily upset as she was not listened to and her concerns regarding her injury were not considered, leading to Dr Kerr failing to further investigate her injury and arrive at the correct diagnosis. In addition, the error made by prescribing NSAIDs could be considered as a simple error that could have been easily avoided by not rushing and not failing to acknowledge the contraindication alert. Jane may also be upset that the treatment plan provided by Dr Kerr did not improve her situation, but in fact made it worse and reduced her quality of life for those 10 days. This error by Dr Kerr led to Jane’s injury lasting longer and caused her to need a further GP and hospital appointment. In addition, the failure of Dr Kerr to apologise for the error made may have also led to Jane being upset and made her feel like the doctor does not really care about her wellbeing.
    If Dr Kerr tried to minimise her stress levels, did not rush as much when it came to Jane and took the time to listen to the patient’s concerns, Dr Kerr may have been able to arrive at the correct diagnosis and implement an appropriate treatment plan to heal Jane’s ankle and avoid the further complications. Also, if the computer system was better at alerting contraindications, perhaps alerting more than once and making it more difficult to miss the alert, Dr Kerr may have not wrongly prescribed NSAIDs to Jane.

  148. Anonymous says:

    1. The A&E doctors quick and ineffective approach to Jane’s examination will have damaged her perception of the doctor and the level of trust she has for that doctor, however it may also result in these feelings to not only the doctors she directly was seen by but others as well. Whilst the GP, who despite having already known Jane takes the time to explore Jane’s situation and listen to her worries regarding the pain being worse than she has ever experienced before for an injury like this. And in doing so shows to be more empathetic whilst also not impacting on the patients experience despite the time pressure they are also under. With the GP Jane will feel a greater trust due to the extra time that was spent helping her to feel as though all her concerns were thoroughly dealt with.
    2. Although the errors made will have undoubtedly caused Jane to feel upset, her feelings can also be the result of not having felt listened to initially and due to the A&E doctor having overlooked the change in pain she had clearly indicated in this injury. In addition as the A&E doctor didn’t go back over and apologise to Jane when seeing her come in for the second time, this may feel her to feel upset from the doctor not acknowledging the mistakes made, and potentially would have had a better experience if an explanation was given by the doctor.
    3. If the A&E doctor had taken more time in gaining information into the patients history and a more thorough examination was taken then the fracture may not have been missed and Jane could have got her surgery earlier, with it potentially not have being as bad due to her not having waited 11 days and not having the correct diagnosis. Furthermore when the alert came up on the computer regarding prescription for NSAID, it should not have been overlooked, it should have been looked into further to understand its significance, due its potential to cause further harm to the patient.

  149. Anonymous says:

    1. Jane’s interactions with the two doctors would provide her with two contrasting opinions of healthcare. Jane’s trust in primary care would be reinforced by her interaction with her GP, who listened to Jane’s concerns and underwent a thorough examination of the injury Jane presented with. The GP provided a more patient specific form of healthcare by listening to Jane’s personal concerns and by taking her medical history into consideration. Jane’s experience in A&E will give her a contrasting, negative view of healthcare. Jane will most likely be weary during any future visits to A&E. The lack of followup by Dr Kerr will no doubt negatively taint her view of patient doctor relationships withing hospitals.

    2. Jane is no doubt upset because of the complication which have resulted from her injury but the problem runs much deeper than that. Jane is upset because her concerns were overlooked and the mistakes made by Dr Kerr were not acknowledged or addressed.

    3. Dr Kerr could have invested more thought and time into Jane’s concerns during their initial consultation. The lack of care taken in regards to the prescription of medication to Jane could certainly also been avoided. Better communication, listening and care on Dr Kerr’s behalf would greatly improve any situation similar to Jane’s in the future.

  150. Anonymous says:

    1) Jane’s interaction with Dr Kerr is likely to decrease her trust in the medical profession because she was misdiagnosed, given drugs which caused her harm and was dealt with in a dismissive manner. This may lead to increased skepticism and mistrust in the doctor’s diagnosis and treatment of any future problems Jane has. However, due to Dr Dee’s behavior, Jane’s trust in the medical profession might be restored, as Dr Dee, despite being busy, listens carefully to Jane so she feels like her concerns are heard, and calls for an X-ray, which leads to the correct treatment for Jane.
    2) The errors made inevitably contribute largely towards the reasons Jane is upset, because if it weren’t for these errors, Jane’s recovery would be a lot quicker, her stomach pain would’ve been avoided, a lot of worry could’ve been avoided and she would’ve spent less time in hospital. However, there are likely other reasons that cause Jane to be upset, such as the impact this injury is having on her by preventing her from being able to run and perform daily tasks as efficiently as she used to. She may also be upset as she may feel that her inquiry was her own fault and that it is causing her to be a burden on her daughter, Sarah. However, Jane’s upset is likely because of the way she was treated by Dr kerr; in a dismissive manner, where her concerns weren’t valued. This upset is accentuated by the lack of apology by Dr Kerr.
    3) Patient Safety breaches in this case could’ve been avoided by Dr Kerr taking more time to fully understand Jane’s problem and by simply listening to her, as then perhaps Dr Kerr may have realized that the pain Jane is experiencing was not due to a sprain. In addition, the stomach pain could’ve been avoided if Dr Kerr had not ignored the contradiction alert about the drugs. These safety breaches both could’ve been avoided by a more thorough and careful, rather than a rushed approach.

  151. Anonymous says:

    1. Firstly, Dr Kerr’s treatment of the situation would negatively affect Jane’s trust of the medical profession. She will feel disappointed as the medical staff have let her down with a rushed diagnosis and a quick discharge, in addition to the inappropriate medication she was given. On Dr Kerr’s behalf this reflects poorly as she did not take the computer notification seriously when it could’ve caused much more significant issues (with regards to Jane’s stomach health). Dr Kerr should have consulted with Jane as soon as the contraindication alert presented on the screen as it would not have led to her being given an inappropriate pain relief. This may lead to Jane feeling disconnected and unimportant as she was not consulted. Furthermore Dr Kerr did not apologise to Jane which further removed her from the situation and was ill-mannered. By comparison, Dr Dee respected Jane’s issue and took time to read her history and rectify the mistake which had been made in A&E. Naturally Jane would have more trust in her GP as the doctor was more aware of her history, but the corrective actions of Dr Dee would have furthered this trust and reassured her that people in the medical profession are honest and trustworthy.
    2. Jane may also be upset because there has been a delay in her diagnosis and subsequent treatment. This could have been avoided and naturally she regrets the actions of the A&E doctor made on the initial visit. However, she may also be upset as she is missing out on her pastime of running with the injury and the scale of her recovery seems to be enlarging now involving an emergency surgery. She may also be upset because she was not listened to on the initial visit, and her intolerance to NSAIDs was not respected and upheld by the doctor on prescribing. This would lead to her feeling disappointed and thus upset.
    3. The A&E doctor should have treated the contraindication alert with more seriousness and consulted with Jane on the matter just to ensure that she was capable or even comfortable with taking the medication – Jane could have informed the doctor of her serious intolerance and the unpleasant side effects which it has on her stomach. The doctor should also have taken more time to review Jane’s case and potentially discuss it with a colleague, regardless of how busy the A&E department was at that time. This could have potentially avoided the surgery if an x-ray was carried out and a more accurate diagnosis made. Furthermore it would have brought Jane onto the road to recovery sooner. It may have caused Jane less stress knowing that the issue was being dealt with and treated, without leaving it to fester over 11 days.

  152. Anonymous says:

    1.The first doctor performed a quick examination ignoring Jane’s concerns and as result he prescribed a medication that affected her stomach. In addition, after
    he realised that he made a mistake he did not even apologise to Jane. This behaviour probably affected Jane’s trust in the medical profession and made her feel that her safety is compromised. The second doctor performed a full examination, order an X-ray to be made and gave her a different medication that alleviates her stomach pain and this could possibly restore her trust. However, her overall experience was not good and it would not be strange if Jane has doubts for future diagnosis.
    2. In my opinion, the main reason Jane is upset is the fact that her initial concerns were ignored and she has to undergo a surgery which could be avoided if the initial doctor gave more attention to what she was saying. In addition, she is upset because the doctor prescribed a medication that he shouldn’t. Therefore, she experienced stomach pain on top of the injury pain.
    3. Patient safety breaches could have been avoided if Jane’s concerns and previous medication history weren’t being ignored.

  153. Anonymous says:

    My Views on Jane’s Story Episode 2
    While working it is very easy to get into a routine way of doing things and while this is unavoidable it can lead to adverse situations such as this. Despite the busy atmosphere of the A&E doctors can’t afford to become complacent as mistakes can be made some of which can be catastrophic. The alert that flashed up has been put in place for a reason and even though it often flashes up for minor issues it should still be acknowledged.
    GP’s often have a rapport built up with their patients and know when to take a patient concern seriously. Mistakes can be made, and they can lead to bad outcomes such as in Jane’s story and the best thing for Jane is that the issue gets resolved as quickly as possible. The original doctor should reflect on this issue and learn from her mistakes, an apology and acknowledging her mistake is the first step in this process.

    Contrast how the behaviour of the two doctors might affect Jane’s trust of the medical profession
    The original doctor has clearly given Jane a negative view of the healthcare system and made her feel angry and upset. The second doctor who knows jane well has taken her concerns seriously and treated her with compassion and respect. Ultimately this will make Jane feel a lot better about the healthcare system. People tend to remember the ‘bad’ things that happen as they are outside the norm and forget the ‘good’ things that they consider to be ‘the way things are done’. This means Jane may forget or downplay the ‘good’ service she received from the second doctor and dwell on the misdiagnosis from the first doctor. If the first doctor apologises for her mistakes and acknowledges what she has done, it may go a long way it is restoring Jane’s faith in the medical profession.

    Is it just because errors were made or are there other reasons why Jane is so upset?
    While she is going to be upset about the errors themselves there is also a lot of other factors at play in this situation. The lack of empathy she received from Dr Kerr and the fact that she felt ignored would make her frustrated and upset, especially since she was proven to be right. The added issues and extra time she have had to spend in pain would make her feel as though the healthcare system and specifically Dr Kerr has let her down. She may also feel because she was ignored when Dr Kerr spotted her, and she has received no apology or admittance of wrongdoing that Dr Kerr is trying to ‘cover-up’ the mistakes.

    Suggest how the Patient Safety breaches in the case could have been avoided
    If Dr Kerr had of spent a little longer in the initial consultation or listened to the patients concerns the entire situation could have been avoided.
    The alert from the computer system should have been investigated, had the doctor even asked Jane herself it would have taken two minutes and avoided the extra pain of a stomach ulcer.
    All consultations should be ended with a safety net of telling Jane that if the pain got worse or anything ese happened, she should come back immediately. This would have avoided Jane waiting so long before going back to see her GP and maybe prevented the condition worsening or jane being in pain for so long.

  154. Anonymous says:

    1. The contradictory behaviour of the two doctors who saw Jane highlights a stark difference in the level of care she received from each. From the outset, such a difference in behaviour between doctors is enough to make a patient doubt the profession. Jane’s family GP was caring, attentive, and provided her with a holistic consultation. Her advice to ignore what the A&E doctor said, and the fact that she had to prescribe a drug to rectify an avoidable issue which was directly caused by the A&E doctor’s actions is very unsettling for a patient. It is disheartening for a patient when they follow exactly the orders given to them by the doctor, and yet they deteriorate. It would be understandable for Jane at this stage to develop a complete lack of faith in emergency health care, perhaps now making her more nervous to go back for further treatment. Furthermore, the fact that Jane sees Dr Kerr and yet Dr Kerr pretends not to see her is even more incriminating for the doctor, making the doctor seem guilty and yet unapologetic, an attitude which would be very disheartening for Jane.
    2. Jane is understandably upset due to being put in a situation which could easily have been avoided. She was not provided with a satisfactory level of care at A&E, leading to her feeling dismissed, not listened to, disrespected, and being misdiagnosed, which in turn led to her condition worsening, and being left in a lot of pain for an unnecessary and avoidable period of time. Not only was she in extreme pain, but she was inconvenienced by this as well as she could not even walk up or down her own stairs. She was left in discomfort due to her stomach, causing nausea and a loss of appetite ,directly caused by Dr Kerr’s errors. She had to refer herself to her family GP due to being seriously concerned about her wellbeing, and this is overall an unacceptable and vulnerable condition to leave a patient in. Watching your condition slowly worsen, being in extreme pain, and being left scared and vulnerable is already bad enough without the added confusion from correctly following incorrect advice given to you, in this case by Dr Kerr.
    3. Dr Kerr could have avoided patient safety breaches by taking Jane’s own concerns into account and not dismissing them, which undoubtedly made her feel very upset indeed. Dr Kerr definitely should have not ignored the contraindication messages – this should always be taken seriously even when a doctor is busy, as it could potentially lead to a life or death situation, and clicking through them doesn’t save that much time any! If a quick consultation is absolutely necessary, then in my opinion, intense focus, interest, and concentration especially important due to the time constraint, and it would have benefitted Jane greatly in her situation.

  155. Anonymous says:

    1. The behaviour of the the first doctor will have decreased Jane’s trust In the medical profession. Not only did the doctor misdiagnose her as a result of rushing through her appointment when she was stressed, Jane was also prescribed medication which was known to produce an adverse reaction in her. By not apologising for these mistakes, Jane will feel that the doctor does not care about her and she will feel like a ‘number’ rather than a patient. Jane may also feel the first doctor was incompetent even though the error was most probably made as a result of being under stress and time pressure as opposed to lack of knowledge. In contrast the GP went out of her way to slot Jane in for an appointment even though the surgery was busy. She took the required time to examine Jane fully and listen to her concerns which had been ignored by Dr Kerr as well as correcting the previous error by prescribing a new medication. This personal and empathetic treatment will have made Jane feel valued.
    2. On top of the errors, Jane will be upset that her personal concerns were ignored at her A&E appointment. As well as this, it would have been upsetting for Jane to have not received an apology, especially considering the amount of pain she has been in for the past 11 days. What makes this worse is that Jane saw Dr Kerr again in the hospital, meaning that there was an opportunity for Dr Kerr to apologise which she did not take.
    3. These patient Safety breaches could have been prevented with better teamwork and communication. Dr Kerr could have let one of her colleagues take Jane’s appointment considering she was ‘stressed’ and this would have allowed her to make better decisions and clear her head. Dr Kerr could also have communicated better with Jane by listening to her concerns and Dr Kerr should have made sure to fully investigate and not just click through serious drug interactions. Also, regardless of how busy the A&E was, Dr Kerr should have took the necessary time to fully examine Jane rather than rushing to a quick diagnosis.

  156. Anonymous says:

    Dr Kerr -She tries to be sneaky by checking Jane’s medical notes upon suspicions. Once this confirms her errors, she is too ashamed to admit to her mistakes and apologise. Instead she avoids Jane to save herself the shame. her pride is costly, whilst her mistakes mean that Jane had to wait 11 days for surgery, was in pain due to misdiagnosis and wrong medication, experienced discomfort in this period, her reluctance to confront her error and apologise cost Jane’s trust in the medical profession.
    Dr Dee comes across as a dedicated faithful doctors, he instills faith in Jane by taking his time with Jane, listening carefully to her as she recounts her experience. He carefully considers her previous illnesses and conditions, values her opinion and values her perception of her illness. He advises to cease taking the harmful NSAID and prescribes her an alternative pain relief. Using his clinical knowledge and by listening to a good history from Jane, he refers her for an X-ray. Because he listened, Jane will now receive correct treatment and is on the road the recovery. Dr Dee is. Great example of how doctors should value and treat their patients, and Jane’s experience with her GP may compensate for the negative experience with Dr Kerr.
    Dr Kerr’s poor judgement in prescribing medication and misdiagnosis, have resulted in prolonged physical pain in Jane’s ankle, discomfort in her stomach and lessened her appetite due to nausea : all impacting her everyday life. This physical harm was avoidable had the doctor listened to Jane .
    Dr Kerr hadn’t been dismissive of the drug alert warning, Jane wouldn’t have experienced prolonged stomach discomfort and nausea due to NSAID given her stomach ulcer problems. Drug alerts should always be investigated, no matter how minor. It is understandable that Dr Kerr felt stressed, but had she been more self aware of this she should HALT. The Hospital should have support systems in place to allow Doctors feeling this way do so, and therefore reduce errors. In practise its maybe difficult to HALT, but a Doctor should do so if their first concern truly is the patient. If the doctor listened appropriately to Jane, this heightened situation could have been avoided. Dr Kerr disregarded Jane’s concerns, not listening to her concerns, and so misdiagnosed her. Furthermore, had she taken a thorough history, Jane’s extended suffering could have been avoided. Doctors shouldn’t work in isolation Doctors who aren’t confident about a diagnosis should seek help from another Doctor.

  157. Anonymous says:

    Dr Kerr didn’t carefully listen to Jane’s concerns, pretended not to recognise her when she returned and didn’t apologise for her error. In contrast, Jane’s GP, Dr Dee who was also very busy, conducted a thorough examination and took time to listen to everything Jane had to say. Hence Dr Kerr’s actions would negatively affect Jane’s trust of the medical profession. Dr Kerr’s original insufficient examination of Jane’s foot caused Jane more pain than necessary. Originally Dr Kerr was trying to save time, however in the long term she wasted time as Jane had to be examined again by her GP and again in A&E. If Dr Kerr had given Jane an x-ray upon her first visit to A&E, doctors time and NHS resources would have not have been wasted and Jane wouldn’t have been put through as much physical and emotional pain. Thereupon, I think that in the future Jane would not trust A&E doctors. On the other hand, Dr Dee knows Jane well and made the appropriate decision to get Jane an x-ray. Dr Dee’s actions would therefore improve Jane’s trust in the medical profession, particularly in general practice.
    No – Jane is also upset because Dr Kerr avoided her upon her second A&E visit and did not follow the ‘duty of candor’ as Dr Kerr did not take the time to apologise to Jane or explain her actions fully. Additionally, Jane is upset because initially Dr Kerr did not build a good doctor/patient relationship with Jane as she did not listen to her concerns or take an appropriate history of her past medical problems. This resulted in the wrong medication being diagnosed which caused Jane harm.
    The patient safety breaches could have been avoided if Dr Kerr took a comprehensive history of Janes past medical issues, listened to her concerns, not ignored the unsuitable medication warning and decided to give Jane an x-ray. This would have been possible if Dr Kerr hadn’t felt so under pressure in A&E. Thus many improvements are required; improve Dr Kerrs actions, improve patient flow in hospitals and reduce waiting times in A&E. These improvements would potentially avoid the patient safety breaches.

  158. Anonymous says:

    1. It is clear that there is a major difference in the way that Jane was treated by the ED doctor and her GP. Through her meeting with the ED doctor, she would have had less faith in the medical profession, given that she was not listened to, was misdiagnosed, and has now ended up with another illness which could have easily been avoided if the Dr had of taken a little bit more time. However, through her GP being so accommodating, it could become clear to Jane not to stereotype all doctors after having 1 bad experience.

    2. I think Jane is initially upset because she feels like she doesn’t have a voice. Before any errors became evident, Jane left the hospital upset. It is important to note that yes, the nature of the errors complicated things for Jane therefore upsetting her due to the inconvenience of the situation, however she was not placed in a position of priority by the doctors, when she was at her most vulnerable, which I think upset Jane the most.

    3. Primarily by communicating more effectively and taking more time to listen to and accommodate Jane, patient safety could have been improved. The notification on the computer also should not have been ignored, as not every patient is the same and it cannot be justified to generalise the notification as not being important for every patient.

  159. Anonymous says:

    1. Jane’s trust in the profession might have been diminished as a result of Dr Kerr’s behaviour. The medication Jane has been prescribed actually caused deterioration of her state rather than an improvement. Moreover, she was misdiagnosed. Dr Dee might have regained Jane’s trust in profession or made Jane feel that GPs are more considerate than the doctors working in A&Es. Overall, the whole situation probably made Jane believe that doctors can make mistakes and sometimes it is good to seek second opinion.
    2. It was not only the errors that made Jane upset. It was also Dr Kerr’s attitude both during the appointment itself and afterwards when she saw Jane in A&E again. Firstly, Dr Kerr did not address any of the Jane’s concerns. Secondly, she did not apologize for her mistakes.Altogether, that could make Jane feel that Dr Kerr was not really concerned with her case and did not try her best to help her patient.
    3. Dr Kerr should have been more careful both while diagnosing the patient and while choosing the treatment/medication. She should have also listened to Jane and address all of her concerns. Moreover, she should have taken the warning regarding the NSAID more seriously and check carefully if the medication is suitable for Jane.

  160. Anonymous says:

    1. Jane may have different opinions on both doctors. The family GP made time to listen to janes concerns and valued her opinion. They acted on her concern and in fact it turned out to be a fracture. Jane may be inclined to trust the medical profession on this occasion. However, the A&E doctor may lead Jane to disbelieve in the medical profession as her concerns were ignored and the severity was downplayed. The A&E doctor also prescribed medication which was unsafe for Jane and caused unnecessary harm. Once the doctor recognised Jane this gave her an opportunity to fix the problem which she did not do.
    2. Jane is upset that the doctors did not listen to her concerns which were justified. Jane was rushed in her initial assessment and therefore a wrong diagnosis was made. She did not receive an apology for the actions of the A&E doctor and there was no accountability and professionalism in this case. She may feel ignored and under valued.
    3. If Janes concerns had have been of value originally and an X-ray carried out they could’ve detected the fracture 11 days prior. If attention was also paid to the alert about the medication and janes stomach ulcers there would also not have been a mix up. Jane was put through unnecessary pain, because the patients safety and needs weren’t met. The A&E doctor did not also provide an apology or explanation to Jane and this means there is no chance of fixing the issue for the doctor and the same mistake is likely to occur again.

  161. Anonymous says:

    1) The behaviour of the A&E doctor would likely damage Jane’s Trust in the medical profession. Dr Kerr failed her patient in several ways including being focused on saving time rather than helping the patient, misdiagnosing her fracture as a sprain and ignoring the drug interaction notification and because of this Jane will likely be skeptical of decisions made by unknown doctors in the future.However, her GP, Dr. Dee listened to her concerns, took the time to check the drug interactions and properly diagnosed her problem, getting her the help she needed which may restore some of Jane’s faith in the profession.
    2) Jane is likely to be most upset about the fact that in the initial examination she was ignored by her doctor, when she was correct that it was not a sprain. These failures were also not acknowledged by Dr. Kerr when Jane seen her again at her second visit to A&E, which likely made Jane more frustrated at the quality of her care at the hospital. An apology and admittance of fault by Dr. Kerr would’ve benefitted Jane more than being ignored
    3) More time should’ve been spent with the patient on the initial examination, listening to Jane’s concerns in order to avoid these Patient Safety breaches. Also all drug interaction notifications should never be ignored even if the majority are minor and won’t cause the patient harm, as you cannot be sure that one patients medical history will be the same as a previous.

  162. Anonymous says:

    1. Jane may distrust her initial doctor and may begin to develop an opinion on emergency care doctors as a result of her delayed diagnosis. She may feel weary of being back in A&E both upset and frustrated at her initial treatment. The more understanding response and quick follow up from her GP may restore some faith and trust in the healthcare service, however, she may also feel that this problem could have been avoided altogether, sustaining her feelings of distrust and frustration.
    2. There will be many factors in this situation which have made Jane upset. Her initial upset will have been due to her poor treatment when she initially presented at A&E and she will be very upset due to the amount of pain and discomfort she has spent the last 11 days. She may be upset as, as a patient, she has felt ignored and that her situation was not taken seriously, to begin with. Jane may feel upset as her initial doctor has ignored her following her return to the hospital, and this reinforces her feelings of neglect from her patient. The exacerbation of her previous health condition may have contributed to her feelings as she is now experiencing multiple problems.
    3. Patient safety breaches could have been avoided if there had been better communication between the doctor and Jane, and by the doctor and the healthcare team. If the A&E doctor had HALT-ed, taken a moment to collect themselves before carefully undertaking Jane’s examination, she may have received an x-ray sooner. The doctor also could have taken more time to evaluate the computer ‘contradiction’ warning to prevent the prescription of a medication that Jane should not have been taking. The initial A&E doctor should take more time to carefully reflect on the situation to prevent a mistake like this from occurring again, rather than just taking a quick moment to decide that they should keep working.

  163. Anonymous says:

    1) The behaviour of Dr Kerr has damaged Jane’s trust of the medical profession. Not only was she not listened to by Dr Kerr but the diagnosis by Dr Kerr lead to her getting worse. This might make Jane think twice before going to the hospital or might prevent her from going at all in the future. The behaviour by Dr Dee might salvage some of Jane’s trust in the medical profession; but this might lead to Jane believing that her local GP ( Dr Dee) is the only one that can help leading to Jane relying solely on her and not any other parts of the medical profession.

    2) Jane is more upset that her initial concerns were dismissed by Dr Kerr, especially since this whole ordeal could have been avoided if the her concerns were taken into account.

    3) Dr Kerr should have taken heed of the medical drug warning indicating that the NSAID could result in harm for Jane.

  164. Anonymous says:

    1. On one hand, the behaviour of Dr Kerr would lessen Jane’s trust in the medical profession, as this doctor did not listen to Jane and treated her in an abrupt and impersonal manner. The doctor also took little care when diagnosing and prescribing for Jane, which left her in a worse state rather than helping or healing her, therefore causing Jane to lose trust in medical professionals. The doctor also failed to apologise for these actions, which may upset Jane.
    However, the behaviour of Dr Dee may restore some of Jane’s trust, as the GP did take time to listen to her and took a thorough history, showing she genuinely cared and wanted to make Jane feel better, leading to a successful outcome.
    Overall, Jane may still be trusting of medical professionals, but may still be wary due to her experiences and therefore ask for a second opinion to ensure the doctor has taken the time to treat her correctly.

    2. Although the errors made would indeed upset Jane, she would also be upset because she feels ignored or disrespected by the doctor as she not listen to Jane’s concerns. Jane may have also felt devalued by the rush of her consultation and the impersonal attitude of the doctor. The fact that the doctor did not apologise for these actions would also upset Jane.

    3. The breaches could have been avoided if Dr Kerr had not rushed but instead, carried out a thorough examination (including history taking) and listened more to the concerns of the patient. Dr Kerr should also not have ignored the drug alert on the computer.

  165. Anonymous says:

    1)Jane has had 2 very different experiences with the doctors. The A&E doctor rushed through her care which resulted in her being dissatisfied, and a mistake was made. The mistakes made were very serious and had a negative impact on Janes health. As a result of this and the way the situation was handled may have made her lose trust for the medical profession. On the other hand her GP took time to make a thorough assessment was made and took her complaints about her pain seriously. This care resulted in her eventually getting the correct care. This may have restored some trust, however doesn’t make up for the initial errors.
    2)I think Jane is upset because of the misdiagnosis, which resulted in her coming to harm and the delaying of her treatment. However I think the main reason she is so upset is that her complaints of pain were ignored. The A&E doctor didn’t listen to her when she described herself as being in more pain than when she had previously had sprains. If the doctor had listened to her and completed a thorough examination the correct diagnosis may have been reached.
    3) In this situation patient safety breaches could have been avoided by better communication. If the A&E doctor had paid more attention to what Jane had said and wasnt rushing over her treatment the fracture may have been spotted. Another way patient safety could have been protected would be for the doctor to have not ignored the computer systems alert, aswell as to double check the side effects of the medication against Janes medical history before prescribing anything.

  166. Anonymous says:

    The first experience Jayne had in A and E in which her examination by Dr Kerr was rushed and she felt that the doctor did not listen to her would have left her very distrusting of the medical profession. The errors made in regard to missing the fracture and prescribing pain medication that worsened her condition would also have impacted her trust in the medical profession. On the other hand the GP who had more time to fully listen to Jayne and take on board her concerns and ultimately make a suitable plan for improved care may have restored some of Jayne’s trust in the medical profession however the poor experiences she had initially are likely to resonate more with her.

    Jayne is likely to be upset both with the errors that were made in regard to her care but also with the poor communication and empathy she received from the doctor Kerr. Obviously, the errors made would upset Jayne, although I think it is the lack of respect Dr Kerr showed when she ignored Jayne when she saw her again in the hospital and the lack of care giver when examining Jayne initially especially when they did not listen and use the information Jayne gave them with regard to the pain she was feeling. This would have led to Jayne feeling like she was not being treated as a person but rather just a problem for this doctor, also making her upset.

    1- Doctor Kerr should not have let a lack of time impact on the concentration and care they gave to Jayne and should have listened to Jayne and how she was feeling. This would have led to a more thorough examination of Jayne that could have led to the broken bone being detected.
    2- The alert from the medical system used by this hospital should not have been ignored when the pain medication was being prescribed. Again, the doctor should have taken their time while prescribing this medication and a proper history examination of this patient should have brought up Jayne’s previous medical problems regarding NSAID medication.

  167. Anonymous says:

    1. The behaviour of Dr Kerr has clearly impacted Jane as she has been left feeling frustrated and upset at the late diagnosis and treatment. Dr Kerr’s lack of consideration for Jane’s experience as a runner and a description of the magnitude of her pain allowed the injury to go unnoticed. Dr Kerr also ignored the warning flagged by the system, which exacerbated Jane’s ulcer condition. This may have left Jane with a sense she has been dismissed and there is a lack of care/ empathy given in her initial visit to the hospital. Depending on the actions of Dr Kerr if she chooses to interact with Jane at a later point may repair the distrust that Jane may be experiencing towards Dr Kerr’s ability and conduct as a doctor. As Dr Dee has a previous relationship with Jane there was trust from the doctor in the doctor-patient relationship that Jane is experiencing severe pain and stomach upset. This allowed for the proper diagnosis to be made and subsequently the appropriate treatment. As this encounter happened after the encounter with Dr Kerr it is possible that Jane’s trust in the medical profession has been restored to a degree. The conduct of the doctors in the hospital and overall experience in the hospital for her second visit may cement her initial doubts or re-enforce the trust in the medical profession.

    2. Although this may be the primary reason there may be other factors that explain why Jane is so upset. With a fracture that hasn’t received timely treatment, Jane may be worried about her recovery time and if there will be any lasting repercussions. This may impact her ability to exercise which for many is vital to their mental health. She also may be worried about the effect the pain medication has had on her stomach and if it will cause a flare-up of her condition, this may cause her upset as she thinks this may affect her ability to work. Jane may also be upset as she feels she has not had time to prepare herself for surgery and consider all the risks.

    3. Patient Safety has been breached primarily by Dr Kerr. She dismissed Jane’s concerns about the level of pain she was experiencing but this could be explained as a human error as Dr Kerr did check guidelines in relation to her diagnosis. A more serious breach of patient safety was to ignore the warning given by the system regarding Jane’s inability to take NSAIDs. However, minor it is best practice to check with the patient if there are any drugs they are allergic to or have experienced any adverse reactions when taking them. The outcome of taking the drugs for Jane is unknown however it could lead to stomach ulcers and the complications that come along with them which can be very serious if left untreated.

  168. Anonymous says:

    1. The behaviour of the two doctors were complete opposites. The A&E doctors did not take the time to conduct a proper examination, listen to Janes concerns or check with about the warning of the NSAIDs. However, the GP conducted a thorough examination, spent the time to listen and understand Janes concerns and noticed that she should not be taking NSAIDs. The GP also ensured that the injury was x-rayed and that Jane had medication to ease how the NSAIDs made her feel. The two differences in behaviour might have led Jane to lose trust in the profession as there was inconsistency with the doctors responses and so she may feel she will not be able to trust another doctors opinion until she get a second opinion in the future.
    2. No, Jane was so upset because she was not listened to and there was no apology for the A&E doctor. Her opinion was disregarded and she probably felt like she was just a number and not a valued person.
    3. Patient safety breaches could have been avoided by the A&E doctor realising that she was stressed and taking a minute to calm down first or talk to her team if she needed some support and assistance. It could also be avoided by listening to the patient and not forgetting how important the communication with the patient is for a diagnosis, no matter how stressed.

  169. Anonymous says:

    1. Jane’s perception of the medical profession through her experience with the first doctor was likely to be along the lines of very little trust. Due to her being rushed through her appointment and not feeling like the problem had been fully investigated. In comparison to her second appointment with the next doctor who decided to go ahead with the x-ray, Jane likely felt more trust towards the doctor and the profession. The second doctor may have had the privilege of more time to listen fully to the problem in comparison to the first one in A&E which may have changed the overall outcome of the situation; however this inconsistency in the two investigations can leave a patient feeling little trust. Furthermore being given the incorrect pain medication, which could have sever consequences, increases the distrust in the profession.
    2. Jane is likely to be upset due to the errors and other factors such as not feeling heard by the doctor when she felt that something was still wrong. A key element of investigating a patient’s problem is to carry this out until the patient feels that their worries have been heard and investigated to a necessary point. Furthermore Jane had to spend a longer than the necessary amount of time in pain, with side effects from the medication and her time being wasted due to having to go back to a GP to get the problem sorted out. These further problems will have contributed to Jane being upset with the situation.
    3. Patient Safety breaches could have been avoided by taking more time with the patient in the first consultation to listen closely to the patient’s worries and to have realised that to out-rule any major injuries that an x-ray should have been ordered. Along with this, all alerts given by the computer system should have been looked into, no matter how minor they may have seemed. Along with this, a ‘debrief’ before the patient leaves the A&E department to clarify the medication given and treatment process could be carried out. This would give a second chance for any potential side effects of medication to be realised, which may have been missed the first time around. This debrief could also allow a health care professional to inform the patient that if it gets worse in the next few days, to come back to A&E or to seek further medical attention, which may have prevented her from waiting 10 days.

  170. Anonymous says:

    1. Dr Kerr’s behaviour during their first meeting would have made Jane feel very uneasy and defeated. She would have felt like she was being brushed off as just another “problem”. These feelings would have been intensified upon meeting Dr Kerr again and being ignored by her. The whole experience would have been quite dehumanising for Jane and very disheartening. Her GP is likely to have made her feel better both physically and emotionally by taking the time to properly listen to and examine Jane. However the lasting impact of Dr Kerr’s behaviour is likely to be what sticks out in Jane’s mind and so going forward she is likely to be very distrusting of the medical profession as a whole.

    2.The errors made would play a huge part into how Jane is currently feeling however it is the manner in which they were made. The errors appear to be a result of lack of interest in Jane specifically and not listening to what she has to say. I think not treating her as a unique individual and just as another patient contributes greatly to why she feels so upset.

    3.Safety breaches could first have been if avoided if Dr Kerr had acknowledged she was feeling stressed with the busy demands of the A&E department and had admitted to herself that she may not be in the best frame of mind to continue working at that rate. Taking a step back may have also given her the insight to be able to hear Jane out the first time and conduct a more thorough examination including a proper history to avoid prescribing NSAIDs to Jane.

  171. Anonymous says:

    1. The behaviour of Dr Kerr in A&E will likely have undermined Jane’s trust in the medical profession. She breached her duty of care to Jane by not conducting the detailed examination necessary, which would likely have picked up on the fracture, leading to earlier treatment. This may have avoided the need for surgery and would have saved Jane a lot of time and stress. In not taking the time to listen to and consider Jane’s concerns, she made her feel unimportant and dismissed, therefore Jane is less likely to speak about her problems to a doctor in the future. The dismissal of the warning about the NSAID would also have undermined Jane’s trust in the medical profession. The GP, on the other hand, would likely have helped to restore Jane’s confidence. They took the time to listen to her history and her concerns and, after taking all of this on board, arranged for appropriate, prompt treatment in order to improve Jane’s condition
    2. The fact that mistakes are made is likely part of the reason Jane is upset, as they led to her being stressed and in pain. However, there are likely other reasons why Jane is upset as well. Firstly she will be upset as she feels like she was dismissed by Dr Kerr, who did not take the appropriate steps to ensure that Jane’s concerns were heard and acted on. This would have avoided many of the problems that resulted. Jane is likely also upset as the errors were easily avoidable; had the doctor listened to her, and also paid more attention to the warning relating to the NSAID, Jane’s outcome would have been much better. The fact that her quality of life has also been impacted – she now finds it difficult to get up and down the stairs – is also upsetting for Jane. Finally, she would also be upset as Dr Kerr had the perfect opportunity to approach Jane with an explanation and apology, yet neglected to do so, again making Jane feel like the doctor does not have her best interests at heart
    3. The patient safety breaches could have been avoided had Dr Kerr firstly realised, before she saw Jane, that she was feeling stressed and under pressure, and taken the time to compose herself before carrying out her examination. Breaches would also have been avoided had Dr Kerr performed her due diligence and taken on board Jane’s concerns regarding the severity of her pain, which would have led to a more thorough examination, a correct diagnosis and more appropriate and timely treatment. Finally, Dr Kerr should have attended to the warning regarding the medication and started Jane on a more appropriate painkiller.

  172. Anonymous says:

    1) Jane’s first experience with Dr Kerr wasn’t a pleasant one, she felt overlooked and the interaction ultimately led to misdiagnosis. On the other hand Jane’s experience with her GP Dr Dee was overall positive. They listened to Jane’s concerns and gave solutions to the problems she was facing. This difference in care may lead Jane to favour primary care and perhaps be reluctant to attend hospital if required in the future.
    2) Jane initially told the doctor that she was sure it wasn’t a sprain and would like to have an x-ray. In that consultation she felt rushed and dismissed. It is likely that Jane was already upset at this treatment but it has been exacerbated by the fact that Jane’s concerns were correct and as a result of the doctor’s dismissal her initial complaint has worsened and she now has another complaint; the stomach pain.
    3) Initially, if care was taken to give Jane an adequate examination, and her concerns were properly addressed the ankle injury would have been properly diagnosed first time round and her condition wouldn’t have been to worsen unnecessarily. Also if the doctor didn’t dismiss the drug warning then Jane’s secondary complaint of stomach problems could have been avoided and Jane wouldn’t have had to experience added pain.

  173. Anonymous says:

    1) As the two doctors offer very different opinions and treatments, Jane is likely to be confused going forward. It may lead her to lose faith in the health care system, making her less likely to return or indeed to be less truthful when she does attend the doctor.
    2) Jane is most upset with how her concerns were disregarded and she was not listened to. She is also upset that things have progressed the way they have done, mainly due to the wrong advice/treatment being given in the first place.
    3) The rushed setting for both the initial consultation and the discharge led to the wrong diagnosis and the wrong medication being administrated. These together led to the worsening of the scenario which could have been avoided had time been taken despite the rushed circumstances.

  174. Anonymous says:

    1. The behaviour of Dr Kerr would have damaged trust in the profession as she didn’t listen to the patient’s concerns, was distracted and rushed through the ankle examination, gave unnecessary NSAID medication and did not apologise to Jane when she realised errors were made. On the other hand Dr Dee took the time to get to know and listen to Jane, especially when she said how much pain she was in, conducted a thorough exam, and also noticed the disparity with the NSAID medication.
    2. Jane is upset as she feels ignored; she was brushed off even when she said that this was unlike any sprain she had before. Her quality of life was also affected by the error as she could not use the stairs and she had unnecessary stomach pain.
    3. Patient safety breaches could have been avoided if Dr Kerr had given a thorough examination and properly communicated with the patient and listened to her concerns. She also should not have ignored the contraindication alert on the computer.

  175. Anonymous says:

    1. Her GP has listened carefully to her concerns, and has actually read up on her medical history. The GP gave her more confidence in primary care, by having her issues finally recognized and resolved. Her experience with the GP shows excellent communication skills, the importance of knowing a patients history and not dismissing potential harm alerts. Her GP was also busy, but took those few extra minutes to make sure Jane knew what she was doing, why she was doing it and that she empathised with her situation. In contrast, the A&E doctor, by ignoring her, proved impersonal and disregarded the mistakes that were made. Jane felt she had not been listened, and an apology may have made her feel as if she could trust secondary care again – without it, she felt snubbed and as if her experience and additional pain were not important.

    2. Jane likely would have accepted an apology – acknowledgement of mistakes and a simply sorry would have made Jane realise her previous doctor was stressed, and that we are all human and make errors. Without that acknowledged, she cannot feel like the A&E doctor has learned and won’t do the same in future, this effecting her impression of secondary care for the future.

    3. Better communication listening to the patients concerns, not ignoring an automatic alert, being more thorough in reading patient history.

  176. Anonymous says:

    1. The behaviour of the two doctors contradicts one another and so will make it more likely that Jane will likely not know who to trust anymore. This may also make it more likely that Jane won’t come to hospital when she is unwell because this negative experience will be reflected upon. Jane may think that certain doctors are incompetent and the care provided at the hospital is inconsistent.

    2. Jane’s concerns were not addressed, even though she stated she thought the pain was more than just a sprain. The doctor dismissed her concerns, thereby not respecting the patients opinion by taking it into consideration.

    3. Patient Safety breaches occurred because Dr Kerr was rushed through the first consultation, furthermore the pressure resulted in quick inaccurate treatments to be given. The lack of careful checking of unsuitable medications also resulted in a breach of patient Safety in terms of the NSAID and stomach ulcers. This resulted in the worsening of symptoms and unnecessary pain.

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