Angry Patient: Post Op Wound Infection after Knee Cyst Removal

Casebank Counselling
1

Where you are:
You are a foundation year 2 doctor in orthopaedic and trauma unit.

Who your patient is:
Mr Emma jones is a 45 year old woman who has come to the outpatient department with some concerns.

Other patient you have about the parent:
She had cyst removal from her knee 2 weeks ago . She developed a wound infection 5 days after she was discharged. She was admitted and treated with intravenous antibiotics and discharged.

What you must do:
Please talk to patient and address his concern.

Patient information:

  • Opening sentence: ”Doctor, I had a cyst removal from the knee 2 weeks ago, I then got a very serious infection.
  • You had a cyst removal 2 weeks ago in this hospital.
  • The cyst was removed from your knee.
  • It was a routine cyst removal.
  • You developed wound infection 7 days after the operation.
  • No one told you that you could develop such a serious complication.
  • You are not happy about it.
  • When you developed post-operative wound infection you went to a different hospital and were treated successfully.
  • You have just come to hospital to complain as we all as to get answers why you were not told about the possible complication of the wound infections.
  • You were told how to clean the wound and how to change dressing.
  • You followed all the post op instructions but still developed infections.
  • Emotions and altitude: You are angry.

Questions:

  1. Why is it that no one told me that I could develop such a serious infection?
  2. Everyone complains about this is hospital. You have too many complications.
  3. What would you do to make sure that this does not repeat again ?
  4. How often do these type of complications happen?

Comments:

  • I came here to be treated properly.
  • I pay my taxes, why are you treating me like this?

Main Points:

  • Apologise
  • Explain that it should have been explained.
  • Ask if signed a consent.
  • Refer to PALS
  • Ask if the cysts was infected or not when it was removed.
  • Ask where did she get treated for the infection.
  • ask smoking, DM, or explained how to change the dressing.

Approach:

GRIPS:

  • Smile
  • Shake hands
  • Maintain eye contact
  • Be appropriately loud
  • Know the name of the patient.

Paraphrase

  • Paraphrase the scenario OR simply say may I know what brought you to the hospital today?
  • I understand that you had an operation for cyst removal 5 weeks ago. How have you been so far since the operation?

Take History of infection:

  • When did you develop the infection?
  • Did you go for treatment?
  • What type of treatment did you receive?
  • Where did you get treated?

Take history of cyst removal:

  • When you had operation for the cyst removal, did someone tell you if it was infected or not?
  • Were you changing the dressings yourself or was someone helping you with that?

History of Risk Factors:

  • DM
  • Smoking
  • After the operation, were you told how to clean and change the dressing

NB: Demonstrate empathy to the patient about the wound infection.

  • Why is it that no one explained to me that I could develop such serious infection?
    • I am sorry that this was not explained well to you.
  • Can I ask did you have a pre-operative assessment?
  • Did the doctor go through with you the complications?
  • Did you read the consent form before signing?
  • Apologise: I am sorry it was not made clear.
  • How prevent in future:
    • We will make a meeting with everyone to make sure everyone gets told about this incidence
  • Organise some teaching for juniors
  • Put reminder on consent to make sure that we can tick to say all complications and necessary information has been given to the patient verbally.
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