Patient Complaint Over Antibiotic Side Effects: PLAB 2 Mock Scenario

Summary:

A 65-year-old male patient, presents to a GP clinic to lodge a complaint after suffering severe diarrhoea and abdominal pain, requiring hospitalization, following the prescription of clindamycin for a foot infection. The case explores adverse drug reaction, doctor-patient communication, apology, complaint handling, and safety netting.

Key Points:

Patient Safety / Adverse Drug Reaction

• Clindamycin (Tindermycin) prescribed for cellulitis in a penicillin-allergic patient.

• Patient developed severe gastrointestinal symptoms post-treatment, diagnosed as Clostridioides difficile infection.

• Adverse effects like diarrhoea and abdominal pain are known risks with clindamycin and should have been communicated.

Allergy Management

• Patient has a known allergy to penicillin.

• Clindamycin is a standard alternative but requires appropriate explanation of risks.

Medical History & Symptoms

• No past medical history or regular medication.

• Symptoms began after two weeks of antibiotic use; patient was admitted for two days.

Communication & Complaint Handling

• Doctor responded with empathy and validated the patient’s distress.

• Apologized for the event and explained possible mechanisms of antibiotic-associated diarrhoea.

• Provided guidance on how to file a formal complaint and offered reassurances regarding follow-up actions by the GP manager.

Important Considerations:

• Always confirm full name and age to verify patient identity.

• Record and verify allergy status before prescribing.

• Explain potential side effects of medications, especially high-risk ones like clindamycin.

• Reassure patients but avoid over-promising.

• Use simple, clear language when explaining medical conditions and treatments.

• Ensure empathy is genuine and not overly scripted.

• Provide informational leaflets for patient education when appropriate.

Diagnostic Approach:

1. Take a focused history of presenting complaint and past medication use.

2. Confirm drug allergies and recent prescriptions.

3. Ask about the timeline of symptoms post-antibiotic use.

4. Consider C. difficile if diarrhoea occurs post-antibiotics, especially if severe or hospitalisation required.

5. Order stool tests (e.g., GDH antigen, toxin A/B assay) for confirmation.

Management:

• Immediate discontinuation of the offending antibiotic.

• Initiate appropriate treatment for C. difficile (e.g., oral vancomycin or fidaxomicin).

• Rehydrate and monitor fluid/electrolyte status.

• Inform the infection control team due to the notifiable nature of C. difficile.

• Educate patient on symptoms to monitor and when to seek urgent care.

• Document incident and initiate formal complaint process if requested by the patient.

Communication Skills:

• Begin with structured introduction and confirm identity (full name and age).

• Show empathy for distress and hospitalization.

• Provide non-defensive, clear explanations of medical events.

• Validate patient concerns and support autonomy in lodging a complaint.

• Offer practical solutions like information on financial support and complaint pathways.

• Reassure with realistic, patient-centered information.

Ethical Considerations:

• Duty of Candour: Be open and honest when things go wrong.

• Informed Consent: Patients must be informed about side effects before medication is prescribed.

• Respect & Sensitivity: Treat patient with dignity, validate emotional response.

• Right to Complaint: Support patients in the process of making formal complaints.

Additional Resources:

• GMC Good Medical Practice 2024: Duty of candour and communication standards

• GMC Ethical Guidance on Prescribing: Good practice in prescribing and managing medicines and devices

• Public Health England Guidelines for C. difficile management