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Harshil
I was on a fourth year attachment and I was doing a ward round with James, a CT1 doctor. We went to see a patient, who had been admitted the day before with chest pain. The patient had a normal ECG and negative troponin, but the consultant who did the post take ward round said he should be reviewed by the cardiology team before discharge as he was at very high risk for ischaemic heart disease. I know that hospitals are under massive pressures for beds, but I didn’t realise how bad it was until that day. The bed manager told James he had to discharge 3 of the team's patients that day – she said the same thing to every team. I guess James felt pressurised. There was no-one else suitable to go home so he discharged this patient and told him to arrange a cardiology referral through his GP. A short while later, we bumped into the registrar who had clerked him; she had come to check up on him and was surprised to find he’d gone home. James told her that the patient discharged himself against medical advice and later I saw him change the notes to say this.
Harshil’s reaction
I was really shocked and surprised by this. They’re always telling us at medical school about how we should make the care of our patients our first concern. I guess James was being pressurised by the bed manager, so I could understand why he discharged the patient, but lying to the registrar and falsifying the notes was totally wrong. I wanted to tell someone, but I really didn’t want James to find out anything about it. I met up with a member of the QAEU and told her what had happened. She said it was really important that the Trust be made aware of James’ behaviour and she forwarded my report to the undergraduate site lead who referred it to James' educational supervisor. She didn’t use my name as I was concerned that there might be repercussions on me.
Outcome
After a few weeks, the member of the QAEU got back to me. She said that there had been several complaints about James from other doctors and nurses and that he had lied to other people as well. His educational supervisor had already given him a warning so now they had reported him to the GMC. He was still working at that hospital, but only under close supervision.
I was glad to hear that no harm came to the patient – he was seen in the rapid access chest pain clinic a few days later and is now being treated by the cardiologists.