Our member was an FY2 doctor in general medicine. One evening, when he was covering nights, he was asked to confirm a patient’s death. He hadn’t been involved in this patient’s care. At handover he'd been advised that the patient had advanced cancer and was receiving palliative care. His death was expected. Our member went to the relevant side room at the end of the ward to complete the necessary examinations and write up his notes.
A week later, the hospital complaints office contacted our member to say that a complaint had been made by the patient’s widow. There were many issues raised about the patient’s care in the hospital, most of which didn’t involve our member. But he was asked to respond to a comment that he had ‘callously walked past’ the patient’s wife without acknowledging her on the night the patient had died.
As this was his first complaint, the member called the MDU for advice on responding. He said that on reflection, although the patient had been alone in the side room, there was a woman’s coat over the back of a chair near the bed, so perhaps he should have realised there was family nearby. He remembered passing a woman returning to the ward as he walked back to the nurse’s station. As he hadn’t been involved in the patient’s care beforehand, he hadn’t recognised her, though now he realised it must have been the widow.
The member was very sorry that he had caused the widow any upset. He said if the nurses had asked him to speak to her, he would have done so. However, he also acknowledged that, due to the visiting restrictions in place during COVID-19 since he qualified, he was not used to seeing relatives on the ward and would not feel very comfortable speaking to a patient’s family members.
One of the member’s concerns was the duty of confidentiality to the patient and how this applied after death. The MDU adviser explained that although the focus must be on the patient, their family and close friends have an important role that should be acknowledged. Their need for support should be met and their feelings respected. Indeed, the GMC accepts that it is usual for doctors to speak to close family and friends of a deceased patient about the circumstances of their death.
The GMC accepts that it is usual for doctors to speak to close family and friends of a deceased patient about the circumstances of their death.
With the help of an MDU adviser, the member wrote a statement for the complaints team. These events also prompted the member to reflect with his consultant on how he might have handled things differently.
Next time, if asked to confirm a death, he would ask the nursing staff whether the family had any concerns or would like to speak to a doctor. He also spoke to his local MDU liaison manager to book our free seminar on communication challenges to attend with colleagues.
This is a fictionalised case compiled from actual MDU case files.
Most junior doctors who began working during the pandemic may have had very little interaction with patients' relatives – if at all. Some of this communication may have been virtual, creating more difficulties, so it’s not uncommon to fail to recognise a patient’s family or friends while on the ward.
So, what can you do to avoid upsetting relatives? Here are a few things to bear in mind.
- Be aware of patient confidentiality, even after death. If you’re aware that a patient raised an objection, then you should abide by the patient’s wishes.
- Make a note of family or friends’ names if they’re regularly with the patient. This may help you remember who you’ve interacted with already or put a face to a name.
- Check if a patient’s family have any concerns or would like to speak to a doctor. You can also ask nursing staff or colleagues who have already had interactions with the patient.
- Get MDU advice if you have concerns or receive a complaint. Contact us and we can walk you through the next steps with a complaint and help you put together an appropriate response.