Who you are:
You are FY2 in the renal unit.Who the patient is:
A 21-year-old male, suspected post-streptococcal glomerulonephritis. You took a renal biopsy from him 2 days ago and have been waiting for the results. Lab said they didn’t receive the specimen. A thorough search was conducted to find the biopsy and it was not found.What you should do:
Talk to the patient, explain what has happened and address his concerns.
Approach
D: Hi, I’m Dr (name), are you (patient’s name)? Can you confirm your age? How are you doing?
Assess knowledge
D: I can see from my notes that you came 2 days ago for a biopsy?
P: Yes.
D: Why did you have the biopsy in the first place?
P: The doctor told me there is something wrong with my kidney.
D: What symptoms did you have?
P: I have blood in my urine.
D: Have your symptoms worsened or have you improved?
P: It’s the same doctor.
D: Apart from this, is there anything else?
P: No.
Challenges
D: How did the procedure go?
P: It went ok.
D: Any challenges?
P: It was painful.
D: How did you cope with it?
P: Nothing was done, but doctor I want to know the result of the biopsy.
Inform about mistake.
D: Do you have any idea why I am talking to you?
P: No.
D: I am sorry, but a mistake has happened. When we took the biopsy from you 2 days ago, we sent it to a lab and we have been waiting for the result but there was no response from them. So, we contacted them and they told us that they cannot find the biopsy. We did a meticulous search and we couldn’t find it either. I am really sorry, but it seems we misplaced the biopsy.
I can’t even imagine, how you are feeling now. I understand that you are upset. It’s our completely our fault. I’m so sorry.
Q. How could this happen?
• Usually after doing the procedure → we label the specimen → someone takes the specimen to the lab
So, The mistake could have happened either in labelling, or the courier misplaced it, or it was lost at the lab.
Q. Who is responsible for this?
• At the moment we are not sure who is responsible; however, we have reported the matter to the concerned department, and we will try to get to the bottom of what happened.
• However, our main concern is you, so we would like to repeat the biopsy to give you the correct diagnosis.
P: It was so painful and it’s your mistake and I am not going to do it again!
D: I know you’re understandably upset, but we want the best for you and we can’t give you any treatment without the biopsy.
P: Why can’t you just treat me without the biopsy?
D: The biopsy was taken to know the cause of your disease and there are multiple causes and we need to find the exact cause. Without the biopsy it would be difficult to give you the right treatment. We are also worried that if treatment is delayed your condition will get
worse.
So, Management
- As you mentioned to me you had severe pain last time so I will inform the relevant doctors to make sure that you are given effective painkillers this time around. We can also give you a sick note for your employer so you can rest off work till you’re better.
- I’d like to examine you to make sure things are ok.
- We will take the biopsy → is it ok if we go ahead with the procedure?
- Incident form.
- RCAM
- PALS.