A matter of opinion - medical case study

BACKGROUND: A pregnant patient, Mrs D, arranges a consultation with her GP, Dr C, to discuss her preference for a home birth. This is the first time Mrs D has raised the issue with her doctor and she intends to ask about the risks and benefits of such a delivery compared to a hospital birth.

Dr C believes it would be in Mrs D’s best interests to give birth in a hospital setting and spends several minutes explaining the various risks associated with a home birth, highlighting the fact that the outcome for mother and baby in the event of unexpected complications can be far worse in home births. Dr C explains that a hospital setting would provide speedy access to an obstetric unit and specialist care should anything go wrong during the birth.

Four days later, Dr C receives a letter of complaint from Mrs D regarding her manner and the nature of the advice offered during the consultation. The patient explains that Dr C’s insistence in arguing against a home birth left her feeling “bullied” and ill-informed and that the doctor did not offer balanced information about the options available. Mrs D’s complaint references recent research highlighting the benefits of home birth for low-risk patients and states that Dr C did not adequately explain these. She says she felt Dr C talked down to her and was only interested in persuading her not to have a home birth. Dr C, she says, should consider changing her attitude when dealing with future patients.

ANALYSIS/OUTCOME: Dr C is surprised to receive the complaint as she believes she was acting in Mrs D’s best interests by encouraging her to have a hospital birth. Dr C contacts MDDUS for advice and a medical adviser helps her draft a response.

In her response, Dr C expresses concern that Mrs D was unhappy with the consultation and goes on to explain that, based on her understanding of the relative risks and benefits, she does not support home births for any of her patients. She apologises for not noticing Mrs D’s distress during the consultation and invites her to discuss the matter further. She closes the letter by informing the patient of her right to contact the health service ombudsman regarding the complaint.

Mrs D responds by reiterating her concerns regarding Dr C’s determination to dissuade her from a home birth and, while accepting the apology, Mrs D decides to de-register from the practice. The complaint is taken no further.

KEY POINTS

• When discussing issues of care with a patient it is important to provide balanced information on the various options available and to actively listen.
• Remember to take into account a patient’s treatment preferences when discussing a course of action, rather than being guided solely by your professional medical views/experiences.