Medico-Legal. Thoughts for locums
Life as a locum can be busy and challenging, but is often immensely rewarding. Locum doctors often have greater autonomy over the extent and nature of their work, enabling them to achieve a work-life balance that suits them.
It also enables doctors to quickly develop their skills over a broad range of clinical areas. For some doctors it is a lifestyle choice, whilst for others it is an opportunity to work in different areas and environments before seeking a permanent post.
Most locum doctors would have worked in posts that were quite different to the way that they had been described. It may be that the systems in use are antiquated, or the support staff are lacking. Whatever the circumstances, locum doctors often face additional challenges they must overcome to successfully deliver good patient care.
In this article we consider some of the key skills demonstrated by effective locum doctors and outline some simple steps you can take to ensure you safeguard your position whilst delivering a high standard of clinical care.
Importance of patient records
Locum doctors are generally more aware of the need to maintain detailed patient records. Good notes are essential to ensure an appropriate handover of patients and to minimise the risks of adverse events. Not only does a good medical entry benefit the patient, it can also provide doctors with a robust foundation in defending themselves against any subsequent complaint or claim.
Record keeping should always be comprehensive and contemporaneous. It’s fair to say that if it’s not in the records, then the general assumption is it didn’t happen. Memories fade and the only way to be sure of what you did and didn’t do is to write it down.
This is particularly relevant to locum doctors, who may only see a patient on one occasion. It is therefore essential that you record all relevant information in the medical records as this may be the only source of information for the next doctor involved in the patient’s care.
Be sure to include details of any follow-up actions such as further investigations or treatment that may be required. MDDUS has encountered cases where patients have presented to locum doctors with new symptoms or clinical signs which have not been effectively documented or handed over. As a consequence, there has often been a considerable delay in the investigation or treatment of serious medical conditions.
In other cases, locum doctors have prescribed contra-indicated medications, usually due to a lack of familiarity with the patient’s medical history. In order to minimise these risks, locum doctors are always recommended to double check any relevant medical information with their patients and document these discussions within their medical entry.
Transfer of information and IT support
Locum doctors often find they are brought into a practice at a particularly busy or chaotic time. In such circumstances, it is easy and understandable for locum doctors to feel the need to “get stuck in” immediately.
However, it is important to be able to appropriately review, record and process information held on medical computer systems and locum doctors should insist that they are provided with sufficient knowledge and training on any computer system used by a practice.
Practices also have a responsibility to ensure locums are safely inducted into the service. They should create and maintain an information pack for locums, containing all the necessary information and guidelines to enable a locum doctor to work safely and effectively. Relevant documents to include in the information pack include patient referral protocols, practice prescribing formularies as well as practice management guidelines.
In terms of access to the computer system, a unique login and password should be set up for the locum doctor to access all electronic patient records. This will ensure that an audit trail of their records is available should the need arise.
All emergency equipment should be pointed out during an introductory walk-round of the practice, with instructions for use of equipment and sterilisation procedures readily available.
Safe patient handover
Poor communication during handovers is a common factor in clinical negligence and regulatory actions encountered at MDDUS. Crucial information can be missed in a busy setting and mistakes can happen in any situation that involves a handover.
This can lead to delayed and incorrect diagnoses, repeated investigations and incorrect treatment. The risks may be all the more apparent to locum doctors who often find themselves on the receiving end of limited handovers.
The very nature of their role means that locum doctors often find they have only a brief involvement in a patient’s overall medical care. It is therefore imperative that they communicate their management and thought-process effectively to permanent medical staff.
An effective and accurate handover protects the patient, ensures continuity of care and allows doctors to prioritise workload according to clinical need. Time should be taken with handovers and patients expect doctors to share relevant information effectively, so that their care is properly coordinated and managed.
Work within competence
A rewarding part of working as a locum doctor is the ability to vary your clinical practice. However, locum doctors are reminded to work within their own competence and should not feel pressurised into taking on an unmanageable volume of work or tasks they feel are beyond their expertise and may affect patient safety.
Particular care should be taken in relation to signing repeat prescriptions. It is not unusual for a locum doctor to find they are handed a large pile of repeat prescriptions to sign at the end of a session. However, all doctors are reminded of the GMC’s guidance on safe prescribing, which highlights that each doctor is individually responsible for every prescription they issue.
Locum doctors should therefore ensure they have sufficient knowledge regarding a patient’s medical history before signing any prescription, irrespective of whether it is a new or repeat medication.
Locum doctors play an increasingly vital role in delivering and maintaining a high level of patient care with the NHS. It is a unique and challenging role and the variety and flexibility of work it affords can be a major attraction.
However, locums can be exposed to greater risks when dealing with patients and failures in communication between clinicians can have serious implications. By taking extra steps and proper risk management, locums and employers can greatly mitigate these risks and ensure continuity of care for patients.
MDDUS (The Medical and Dental Defence Union of Scotland) is a medical and dental defence organisation providing access to professional indemnity and expert medico- and dento-legal advice for doctors, dentists and other healthcare professionals throughout the UK. For further information on MDDUS go to www.mddus.com.