Annex A > Chapter 17 - Communication Between Healthcare Professionals and Patients > Communication after the operation and when the child died
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Communication after the operation and when the child died
The clinicians' evidence
335 Dr Joffe told the Inquiry about the measures taken to co-ordinate the child's care with the health visitor service, or the GP, in order to ensure that parents were supported:
`... with regard to the general practitioner, the parent is given a brief note at the time of discharge, something of the diagnosis noted, the major elements of treatment provided during the admission, and with a list of the drugs which he or she should continue to take, and the doses. That information is given to the parent who is asked to take a copy to the general practitioner as soon as reasonable.
`In addition a more detailed summary of the patient's admission is sent, usually within two or three weeks, with more detail of what took place during the admission and with information. Incidentally, the first form would have information about the next expected visit to outpatients, and the nature of the condition and the treatment would be expanded in the case summary, which would be sent to the general practitioner. Occasionally, if the health visitor has been involved previously, and is known, a copy of that summary could be sent to her, and was sometimes done.
`In patients where there are community elements involved, social services, et cetera, a communication is normally sent from the senior nursing staff or the cardiology counsellor to these various services, to inform them of the patient's status at the time and, again, their medication that they would be taking.' [394]
336 As regards follow-up and monitoring, Dr Joffe indicated that generally any patient without symptoms might be told to return in six months, whereas a symptomatic patient would be given an earlier follow-up and appropriate information at each visit. [395]
337 Dr Joffe described his practice when a child died:
`If a child died, I was always ready to arrange to talk to the parents at a mutually suitable time, if requested by the surgeons or the parents themselves.' [396]
338 Mr Dhasmana stated that he dealt with parents as sensitively as possible, although he acknowledged that being open and frank, which he felt was necessary when speaking to parents, did upset some of them. [397]
339 As regards communicating with parents after operations whatever the outcome, Mr Dhasmana stated that he:
`... always made a point of talking with parents after a bereavement, or if the child had suffered a permanent disability.' [398]
340 As regards communicating with parents whose child had died, Mr Dhasmana stated:
`I learnt that it was important to speak in clear terms about the event, with as much sensitivity as possible. ... I would talk with the parents accompanied by a senior nurse and expect her to provide further support and information to the parents after my meeting with them. ... I always offered to see the parents again, if they desired, when I would discuss the post-mortem findings with them. My junior staff would also ring the family doctor so that arrangements could be put in place for the family to be visited soon after their return home. I would personally write a brief summary of the medical report and forward this, with the autopsy findings, to the family's GP...' [399]
341 As regards communicating with parents whose children suffered some disability after the operation, Mr Dhasmana stated that:
`In the case of a child suffering a disability i.e. neurological damage, I would talk with the parents and inform them of the problem. Unfortunately the information I could provide was incomplete, as the extent of neurological injury and permanent disability would not be known for a few weeks post-operatively. I used to be as sympathetic as possible ... I would ensure that parents understood that a recovery might not occur and explain that a neurologist would explain the situation and prognosis to them in more detail ...' [400]
342 Mr Wisheart stated that he had discussions with the parents and both the surgical and nursing teams once the child's discharge time had been determined. The topics discussed included:
`... medication, the activities which the child may indulge in, the care of the [surgical] wound, the role of the General Practitioner and District Nurse, the next outpatient's appointment ... the future and particularly about any foreseeable complication or need for further surgery. It was my personal practice always to ask children to attend my outpatient clinic at least for one or two visits following surgery.' [401]
343 Mr Wisheart explained that after discharge, patients were seen by the paediatric cardiologist, or the surgeon, from time to time, but that the day-to-day counselling and support was provided by the primary care team and also by the paediatrician in the District General Hospital. [402]
344 Mr Wisheart stated that it was his practice to inform the GP when a child died. He stated that usually the referring paediatrician was also informed, but that this was sometimes `overlooked'. [403]
345 Mr Wisheart described his practice after the death of a child:
`I, together with a nurse and/or the counsellor, always talked with the parents of a child who died as soon as possible after that death ... Towards the end of the conversation I informed parents ... it was highly likely that [the coroner] would require a post-mortem examination ... I invited the parents to meet with me again when the stress and emotion was less immediate. I normally suggested that six weeks or later would be appropriate, but it was left to the parents to decide when they felt it would be helpful. I indicated that this would be an opportunity to review all the circumstances leading up to the child's death and also to consider any new findings that might have been identified at the post mortem examination. I did not keep a detailed record but I imagine about 50 per cent of parents took up that offer ... If the parents wished, the services of the paediatric counsellors were available for a long time after the child's death.' [404]
346 When a child suffered some disability, often in the form of neurological damage, Mr Wisheart stated that the primary objective of the cardiac team was `to ensure that the best specialist advice available in the field is provided for the child and the family.' [405] This included advice, support and counselling services and community and social services.
347 Mr Wisheart stated that the cardiac team did not withdraw from the care of the child once the neurological specialists became involved:
`They continue to see the child and to have a role, sometimes as part of a team and sometimes as the one performing a key co-ordinating role of a number of services who are providing care to the child.' [406]
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Footnotes
[396] WIT 0097 0317 Dr Joffe
[397] WIT 0084 0104 Mr Dhasmana
[398] WIT 0084 0103 Mr Dhasmana
[399] WIT 0084 0103 Mr Dhasmana
[400] WIT 0084 0103 - 0104 Mr Dhasmana
[401] WIT 0120 0232 Mr Wisheart
[402] WIT 0120 0232 Mr Wisheart
[403] WIT 0120 0234 Mr Wisheart
[404] WIT 0120 0234 - 0235 Mr Wisheart
[405] WIT 0120 0236 Mr Wisheart
[406] WIT 0120 0236 Mr Wisheart