Case 5: raising concerns

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Clinical case:

Harshil is a fourth year medical student. He is doing a ward round with James, a CT1 doctor. They go to see Mr Collins who was admitted the day before with chest pain. Mr Collins has a normal ECG and negative troponin, however the consultant who did the post take ward round has asked for him to be reviewed by the cardiology team before discharge as he is high risk for ischaemic heart disease. Harshil is present when the bed manager tells James that he has to discharge three patients that day due to bed pressures.

James feels pressurised, and cannot identify anyone suitable to go home. He therefore discharges Mr Collins and tells him to arrange a cardiology referral through his GP. A short while later Harshil and James bump into the registrar who clerked Mr Collins; she has come to check up on him and is surprised to find he’s gone home. James tells her that the patient discharged himself against medical advice. Later Harshil sees James change the notes to say this.

Question: Does Harshil have a moral, legal or professional duty to do anything? If so, what?

Discuss now on Twitter, using the hashtag #quclms. Follow @quclms for updates.

Question setter and expert: Dr Alison Sturrock, sub-dean at UCL medical school and lead for the GMC development unit at UCL which designs assessments for doctors referred to the GMC with possible performance problems

With thanks to Dr Jayne Kavanagh, Ethics and Law Lead

*** Since the themes and issues of this case are relevant to medical students and doctors, we have an opportunity to share experiences and learn from each other. To help us to do this we will be linking up with a GMC tweetchat on raising concerns on Friday 21st June between 12 and 1pm. You can follow the GMC @gmcuk. The hashtag for the tweetchat will be #GMCchat. You can read more on the GMC’s blog. Please do respond to the #quclms case as usual, but if you’re free on Friday it would be great if you could also join in with the #GMCchat. ***

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