See One, Do One – 9th August 2008

See One, Do One

BMA News, 9th August 2008.

Aidan M. O’Donnell. 

Late one afternoon, I took my last patient to the recovery room. In the corner I saw Nina, a recovery nurse, in tears, being comforted by a couple of her colleagues. She told me she was very worried about her friend who had been admitted that day. The story was that the patient, a fit and healthy 25 year old woman, had a sudden headache, and collapsed unconscious. When she came round she was drowsy and had difficulty talking. She was admitted to the hospital, under the care of acute medicine, where she had not had a CT scan of her brain. Instead they had waited many hours before performing an MRI scan. Nobody had revealed the results of the scan.

When Nina had gone to the ward to see her friend, she was still drowsy and couldn’t talk normally. The staff had refused to say anything to Nina on grounds of patient confidentiality. The patient’s parents lived far away but they were on their way to the hospital at that moment.

Nina asked me if there was anything I could do. It sounded as if the patient had suffered a subarachnoid haemorrhage, and had a significant cerebral insult. She should have had a CT scan as an emergency, not an MRI scan several hours later. She might even need neurosurgery. I wondered what was going on and whether she was being mismanaged. I tried to find her scan result in the computer but it wasn’t there.

I asked my consultant what he thought and his advice was “stay out of it”. I ignored his advice and went to the ward, and read the casenotes, even although she was not my patient.

What I read was a very different story. She wasn’t a healthy patient. In fact she had had several recent admissions with transient neurological symptoms, and the presumptive diagnosis was of demyelinating disease. She hadn’t collapsed suddenly that day but instead had deteriorated over the preceding few days in association with a febrile illness, presumed to be a UTI. Since admission she had been seen by two consultants, one of whom was a neurologist. I could find nothing in her notes to indicate anything other than that she was being managed extremely well as an acute exacerbation of multiple sclerosis.

I closed the notes very quietly and sneaked away. By the time I saw Nina again, she already knew.

I had, in all willingness to help, broken rules of patient confidentiality, only to discover that my conclusions were dead wrong. This was a stiff lesson in not going off half-cocked and poking my nose where it doesn’t belong, and trusting my colleagues to be doing the right thing for their patient.

Aidan O’Donnell is a consultant anaesthetist from Livingston. At the time of this case he was a trainee in another trust.

Copyright © Aidan O’Donnell 2008.
This article first appeared in BMA News on 9th August 2008.
Unauthorised reproduction prohibited.