Dubai doctors warned to make careful notes of advice to patients

Doctors warned complaints are increasing and writing things down is the equivalent of a 'black box'.

DUBAI // Communicating clearly with patients and making detailed records of everything said is crucial for doctors in the event of malpractice suits, a conference heard.

Doctors were warned that complaints were increasing and writing everything down is the equivalent of a “black box”, which could prove all-important if an error occurred.

The Dubai Health Authority (DHA) revealed last month that more than 500 medical complaints were filed against doctors, private and public hospitals and clinics in the emirate last year.

They ranged from minor grievances to failures that led to patients’ deaths.

“When an error happens we ask for the medical file, which is what we consider as our black box,” Dr Layla Al Marzouqi, head of DHA’s clinical governance office, told the International Family Medicine Conference on Monday.

“If a patient complains that the doctor didn’t inform them it is your documentation, both verbal and written, that will save you. Your medical director and your colleagues cannot save you but a well-documented file will.

“Patients expect clear explanations of symptoms, the disease, treatment and possible complications, and when doctors cannot fulfil this then it increases the chance of complaints.”

Dr Al Marzouqi told of a young girl whose finger was amputated when her family was told it would be cosmetic surgery to rectify an injury.

Then there was a patient who had a successful knee replacement operation but died when given an antibiotic to which he was allergic.

“Imagine if this was someone you knew, how tragic it would be,” Dr Al Marzouqi said. “It will take less than 20 seconds to double-check the patient’s name with the medication on the file and to write extra information on the patient’s history.”

The DHA has partly attributed the number of complaints to the community’s greater awareness of their rights, and to stricter standards.

Poor communication with patients was the main cause of complaint in 65 per cent of cases in a separate DHA study from 2010 to last year.

A breakdown in communication could happen during a shift change and patients at greatest risk were the elderly, children, those with low income, patients without a high school education and those who did not speak English as their first language.

Major cases involved over-medication, duplication of medicine, services that increased healthcare costs and surgery on the wrong area of the body.

Minor cases included rescheduling appointments and patients who were prepared for surgery when the surgeon was not available.

Doctors should familiarise themselves with the UAE’s Medical Liability Law, Dr Al Marzouqi urged.

The law defines malpractice as when an error occurs due to negligence, insufficient effort, ignorance, or unfamiliarity with technical aspects all practitioners are assumed to be familiar with.

High patient volumes could not be an excuse, Dr Al Marzouqi warned.

“You cannot come to me and say there are too many patients and it is an administrative problem,” she said. “You need to talk to your medical director to resolve this.”

But doctors spoke of being burdened by the stream of patients at primary healthcare centres.

Senior doctors said documentation was mandatory and part of annual performance evaluations as part of the Ministry of Health guidelines since last year. Young residents said they faced pressure to quickly complete the paper work.

“Even if we are passionate and want to write more details we are given a consultation time of 12 minutes per patient,” said one doctor.

“It is a healthy habit because we can save a patient’s life and we will become good doctors,” said another resident. “But we must have time to write in detail to prevent mistakes.”

The three-day conference in Dubai attended by local and international doctors, paramedics and nurses ends on Tuesday.