If you continue without changing your settings, we’ll assume you’re happy to receive all cookies from the BMA website. Find out more about cookies
When you visit any web site, it may store or retrieve information on your browser, mostly in the form of cookies. This information might be about you, your preferences or your device and is mostly used to make the site work as you expect it to. The information does not usually directly identify you, but it can give you a more personalised web experience.
Because we respect your right to privacy, you can choose not to allow some types of cookies. Click on the different category headings to find out more and change our default settings. However, blocking some types of cookies may impact your experience of the site and the services we are able to offer.
These cookies are necessary for the website to function and cannot be switched off in our systems. They are usually only set in response to actions made by you which amount to a request for services, such as setting your privacy preferences, logging in or filling in forms.
You can set your browser to block or alert you about these cookies, but some parts of the site will not then work. These cookies do not store any personally identifiable information.
These cookies are required
These cookies allow us to know which pages are the most and least popular and see how visitors move around the site. All information we collect is anonymous unless you actively provide personal information to us.
If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance.
These cookies allow a website to remember choices you make (such as your user name, language or the region you're in) and tailor the website to provide enhanced features and content for you.
For example, they can be used to remember certain log-in details, changes you've made to text size, font and other parts of pages that you can customise. They may also be used to provide services you've asked for such as watching a video or commenting on a blog. These cookies may be used to ensure that all our services and communications are relevant to you. The information these cookies collect cannot track your browsing activity on other websites.
Without these cookies, a website cannot remember choices you've previously made or personalise your browsing experience meaning you would have to reset these for every visit. In addition, some functionality may not be available if this category is switched off.
Our websites sometimes integrate with other companies’ sites. For example, we integrate with social networking sites such as Twitter and Facebook, to make it easier for you to share what you have read. These sites place their own cookies on your browser as a result of us including their icons and ‘like’ or ‘share’ buttons on our sites.
The wooden benches outside the coroner’s court seemed almost inviting after the bland, unheated reception.
There were no toilets, no source of water — just three doctors and a barrister.
I had two voices in my head; one was intermittently mocking, damning and scolding me. The other was quieter. It said I had tried hard and been thorough. I had to strain to hear it.
We were escorted into the courtroom. Members of the deceased’s family were there.
The coroner began the hearing by reading the family’s statement. It was scored with anger and distress. They had googled ‘endocarditis post a pacemaker insertion’, and in their eyes the diagnosis should have been straightforward.
The family had concerns about the information they had received from NHS 111 and the standards of care in hospital. Perhaps what upset them the most was that when Mr Kaplan’s pacemaker had been adjusted, a few weeks post-insertion, the cardiologist had turned it down and said this would help save the battery.
For months, a question had tortured them: had their husband and father died to help the save the life of a battery?
The first of the doctors, the patient’s GP, read his report. Mr Kaplan had phoned him to report lethargy and shivering. The GP had safety-netted in terms of chest pain and worsening symptoms. The family had no questions for him.
‘All their anger is being saved up for you,’ said the voice.
I had seen Mr Kaplan the day before he was admitted to hospital. I managed to recall the episode methodically, keeping eye contact with the family. I sincerely believed that I had been thorough and caring.
Next up was the cardiologist who had inserted the pacemaker. He said that on admission, Mr Kaplan had been diagnosed with sepsis, thought to have come from either his urine or chest. He had been treated with IV antibiotics and on his third day in hospital endocarditis was considered and investigations were carried out to confirm vegetations on the pacemaker lead.
For the first time, he was able to explain about ‘saving the battery’ to the family. He described it was a routine step for pacemakers to be turned down once the leads became secured by fibrous tissue. While it does save battery life, it is not carried out with this intention.
The cardiologist confirmed that the risk of infection (around 1 per cent) had been outlined as a possible complication when the pacemaker was inserted. The coroner recorded a verdict of death by misadventure.
It was healing for me, as I was able to reassure myself of the treatment I had given, in preparing for the hearing and in a conversation with the cardiologist afterwards.
Having dreaded the day, I found myself wishing we had time to create a narrative around every patient we encounter.
Gwynne Meijer is a GP in Kent
Mr Kaplan is a pseudonym
Regrettably, this scenario is going to become even more common.
Every doctor will face inquests now since the law has changed recently, so that all deaths in hospital now are closely examined to see whether there is any evidence of any possible negligence or criminal negligence.
The current culture of the NHS is now directed at finding scapegoats, and the profession is a very easy target to deflect attention from the organisational failings that are now endemic in almost every NHS Trust, particularly with the care offered to frail elderly demented patients who need old fashioned nursing care.
I suggest this doctor and all doctors access the Medical Protection Society's website and attend the excellent CME/CPD accredited 6 courses on assessing your risk, handling difficult patients and difficult colleagues.
Their elearning packages are available to any doctor and free to members.
Any doctor facing a coroner's inquest would also benefit considerably from attending 2 of the 4 modules in the Bond Solon/Cardiff University training courses.
The modules concerned are Court Procedure and Cross Examination Day, where a small number of individuals with a variety of expert witness expertise are subjected to fierce cross examination by a barrister under courtroom conditions.
There is a preliminary report writing session which is separate from the above court procedure courses, which will prepare delegates for the cross examination day, which to comply with Bar Council rules has to be conducted on an "old" case.
The Cross Examination Day consists initially of a buddy system, where each delegate is paired with another.
Each delegate presents his buddy's case succinctly.
The delegate whose case is presented then undergoes videod cross examination and receives a copy of his cross examination video at the end of the day.
Delegates can do the whole course piecemial and complete other modules covering criminal and civil procedure, court procedure, contract & tort law.
The certificate of success is supplied after the video is marked by the Cardiff University Law Faculty.
I recommend the full course, which will provide any doctor facing any GMC, NCAS, PCT/Trust investigation with the tools and self confidence to withstand bullying, battering by their employer and investigation by the GMC.
Best Wishes to all those increasing numbers of doctors and other healthcare professionals who find themselves caught in the headlights or their employer, the Coroner and the GMC, regardless of fault.
WE NEED TO REFLECT ON "MINCING" OUR WORDS.
"Saving the Battery" could be put as " reducing the times you will need operations to insert another batteery".
we need to remember that "loss lead to anger" and this anger will be directed at the medicval profession.
I cannot agree that there is anything regrettable about giving bereaved families a clear account of the circumstances in which a family member has died. It should be an essential part obtaining closure.
Having spent twenty odd years prior to retiring in dealing with Inquests, acting as my employing trust's advocate in the Court, I came to appreciate the contribution a well conducted inquest can make to giving closure. It can be an essential part in the grieving process. Mishandled it can compound distress. After retiring I had to dispute the pathologist's report at my own Mother-in Law's Inquest; a further expert opinion confirmed my objections as well founded.. Resolving this took two hearings and was distressing for my relatives.
In over a hundred inquests barristers were present on three occasions. I have to say they don't really help the family much when they do appear, because the Inquest is not a trial, but an examination of the facts. Cross examination skills are simply not needed, and normally have no place in an inquest. Some barristers do not appreciate that, and may need to be restrained by the Coroner if they put pressure on vulnerable witnesses.
In my experience doctors from all branches of the profession, except pathologists who regularly appear at Inquests, need help to prepare, and require personal support during and after the proceedings. It is always a source of anxiety to be called to give a factual account of one's actions in what is deliberately, a very serious and formal setting. In my view at least it is right and proper that this should be so. However, it was also my experience that many professionals are left to their own devices, and not adequately supported when they do have to go to Court.
In any doctors professional life having to face inquests/complaint /regulatory body's enquiries etc are facts of life.
However there is a sense of fear or dread or a feeling of isolation imposed upon that doctor because as soon as to investigative mechanisms kick in every only seem to want to disengage from that doctor and offer perfunctory,formal words of support or a pretence put on.
Most doctors when their professional integrity is threatened they go to pieces
When you truly,sincerely,honestly,conscientiously,diligently contributed to to wellness of your patient your should not fear the outcome if not the intended,instead rely on the wisdom that outcomes are now entirely dependent on your carefully planned actions
Medicine is not a pure science and take heart from that
My best wishes to all such doctors
Dr Parsons is incorrect - the recent introduction of the Coroners and Justice Act has not changed the way deaths in hospital are investigated. The Act does contain plans for a Medical Examiner which will change things but that part of the Act has not yet been implemented.
Dr Hewett is right - there is no cross examination in a Coroner's Court. It is "inquisitorial", a fact finding exercise, with the Coroner asking most of the questions. Having recently been appointed as an Assistant Coroner, I have been pleasantly surprised to find that Coroners see helping the family understand what happened as a major aim of the Inquest (I had previously seen it simply as a legal exercise). They want doctors to engage with the family when giving evidence and use lay language when explaining the medical issues.
Most Coroners go out of their way to put witnesses at ease. Indeed the Coroner is not allowed to apportion blame to an individual in reaching a conclusion / determination (previously called a verdict) and will not allow any questions which might incriminate the doctor. Obviously if there have been any issues with the care these will be brought out in the exploration of the facts although the scope of the Inquest is limited to answering the question of how the patient died.
With the new legal "duty of candour" on Trusts to be open with families, there should not be any surprises in the Coroner's Court.
As a nurse my first encounter was traumatic. Indeed, I was diagnosed with PTSD by my GP after a 2 hour grilling about child safeguarding which neither myself nor my Trust colleagues or Trust appointed solicitor had anticipated. Further numerous conversations with my colleagues since have been unable to ascertain any wrongdoing on my part. The coroner in question had a very bad reputation. I reported her to the Royal Court of Justice, as advised by the Royal College of Nursing. It was my first experience of English justice and I was left deeply unimpressed. In fact, if anything were to happen to a family member of mine, I would request that another authority deal with the death.
I was left out to dry by the Trust Service Liaison Department and the Trust solicitor. If I had the money, I would engage a barrister personally. If this is English justice, God help us all.
Should the coroner advise family that another trust could be appointed to investigate
We see how much it is tough to spend even a day in court. The https://hiscopes.com figure out your situation right now.