The MDU in action
Dermatology and cosmetic clinic cover scenario
27.09.24
The following is drawn from the real life experience of MDU risk advisory partners supporting healthcare organisations at times of crisis. It illustrates the depth of support and guidance available to MDUConnect members.
The scenario
A 33-year old woman attended a cosmetic clinic for advice on treatment of deep 'smile lines' in the nasolabial folds and loss of fullness and definition in her upper lip. Following a discussion, it was agreed that she would return the following week for collagen dermal filler treatment.
The treatment was provided without apparent complication, and the patient was given an information sheet to take away.
Five days later, the patient called the clinic distraught, as the areas where filler had been injected were lumpy and unsightly. She was reviewed that same day, and it was clear that there were several non-erythematous nodules in the areas that had been injected with filler.
The patient was reassured that the nodules would not be permanent and would resolve naturally, without further treatment.
Two weeks later, the clinic received a letter of complaint from the patient. She said that the clinician had played down the risk of any complication, saying it was a safe procedure. The patient stated that, if she had known she might look worse after the treatment, she would never have had it in the first place.
She demanded a refund of her fees and threatened to post negative reviews on social media.
Risks and impacts
In a scenario like this, of course a medical malpractice claim can arise, but there are many other avenues of potential investigation, some of which impact the corporate entity itself.
They include:
- Complaint: a common impact that must be dealt with quickly and sensitively
- CQC obligations: there is a need to follow the statutory duty of candour processes
- Digital media: the risks of reputational damage following a patient’s review cannot be underestimated, particularly if the review is shared on social media.
Support from an MDU risk advisory partner
In a scenario like this, an MDU risk advisory partner (RAP) would be able to step in, supporting the business and ensuring that the incident and any fallout are dealt with in an efficient and professional manner. This support could include:
- Duty of candour guidance: advice to the clinic on discharging its duties in accordance with the statutory duty of candour. Timescales for duty of candour notification to the patient are set out in statute and are short (notification is to be made as soon as is practicable).
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Risk management advice: the process of explaining procedures to patients, must include benefits and risks, in order to obtain informed consent. Seeing the patient before treatment offers a good opportunity to provide both bespoke advice and general literature on dermal fillers.
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Complaint resolution: advice on a suitable draft response to the complaint, including advice on how to approach making an ex-gratia payment of the cost of the treatment fee. Although the patient had threatened to post negative reviews about the company on social media, dealing with the complaint promptly, empathically and professionally is likely to lessen the risk.
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Employee disciplinary support: if considered necessary, advice (via partner organisation) on disciplinary/employment matters relating to the clinician. The (Peninsula) team provides 24-hour employment law and health and safety advice through dedicated consultants with in-depth experience in employment legislation, contractual requirements, and case law precedents; telephone coaching when managing difficult or complex employee relations and access to a team of specialist solicitors who can advise on contractual matters.
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Reputational risk: advice from the MDU’s media team on how to manage scrutiny on social media, taking into account the need to maintain strict patient confidentiality.
This page was correct at publication on 27th September 2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
Sarah Jarvis
Risk advisory partner
Sarah has been a full-time medico-legal adviser since 2013, and has wide experience of supporting healthcare companies in dealing with complaints, inquests and general medico-legal queries.
A GP partner and trainer before joining the MDU, she is a team leader in the advisory department, where she also draws on experience gathered from sitting as an MPTS fitness to practise panellist, including chairing the panels.
Oliver Lord
Risk advisory partner
Oliver is part of a specialist advisory team that assists members with disciplinary investigations and has an interest in doctors’ wellbeing.
Before joining the MDU in 2013 Oliver was a consultant psychiatrist in a crisis resolution team. He provides regular talks and courses to members on medico-legal issues, conflict resolution and unconscious bias.
John Dale Skinner
Risk advisory partner
John is a medico-legal adviser and risk advisory partner. John has been with the MDU for the past 10 years, having previously worked as a GP.
He has wide experience as a senior medical claims handler helping MDU members defend clinical negligence claims.
Kathryn Leask
Risk advisory partner
Kathryn has been a medico-legal adviser with the MDU since 2007. She is a team leader and trainer in the medical advisory department.
Before joining the MDU, she worked in paediatrics, gaining her MRCPCH in 2002, and holds a CCT in clinical genetics. Kathryn also holds an MA in Healthcare Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and deputy chief examiner for the faculty.
Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).
Jerard Ross
Risk advisory partner
Jerard has been with the MDU for over 10 years, and now works as a risk advisory partner.
Prior to joining the MDU, he was a consultant neurosurgeon balancing a busy NHS practice with private sector work. He is currently the educational lead for the MDU and head of Scottish affairs.
Ed Farnan
Risk advisory partner
Ed has been a medico-legal adviser at the MDU since 2013, and now works as a risk advisory partner. In addition to providing advice and assistance to members. Ed has worked as a clinical risk manager in the underwriting department and as a member of the medical education team.
After qualifying from Queen’s University Belfast in 1995, and as a GP in 2000, he worked as a partner in general practice for around 12 years before joining the MDU.
With an interest in clinical governance, Ed sat on a regional research ethics committee, completed a master’s degree in medical law in 2011 and became a Fellow of the RCGP in 2015.
Ed also writes articles for the MDU and other publications as well as running courses and webinars.
Leo Briggs
Risk advisory partner – dental
Leo is a risk advisory partner specialising in supporting dental practices in dealing with complaints and regulatory matters, as well as general dento-legal queries.
Having qualified from University College Hospital London in 1989, he has worked extensively in the Community Dental Service as well as in general dental practice. Leo also gained an MSc in Periodontology from the Eastman in 1995 and is on the GDC specialist register for Periodontics.
Leo worked part time as a clinical tutor at the School for Professionals Complementary to Dentistry in Portsmouth and started working part time for the DDU in 2005. He has been with the DDU full time since 2009 and became deputy head of the DDU in 2016.
Sarah Ide
Risk advisory partner – dental
Sarah is a risk advisory partner and has been working at the DDU as a dento-legal adviser since 2015, initially combining this work with general practice.
She qualified from Guy's Hospital Dental School in 1992, working there as a house officer before entering general practice as a vocational trainee.
Sarah subsequently worked in independent and private general practice for 25 years and completed an MSc in Aesthetic Dentistry at King’s.
