The Medical Defence Union, the UK's largest medical defence organisation, has revealed it paid out nearly £3m in compensation on behalf of GP members to settle 30 claims arising from the treatment of patients with depression during a recent ten-year-period.

In the latest edition of the MDU Journal1, Professor Femi Oyebode, consultant psychiatrist and MDU Council member, analysed the main reasons for claims relating to the diagnosis and management of patients with depression (excluding post-natal depression). He commented:

"Depression is a relatively common presentation in general practice and in most cases, the care of patients with depression is generally straightforward and without incident. However when something does go wrong, the nature of the condition and the type of medication involved means there is significant potential for an adverse outcome, including the risk that the patient will harm themselves in some way, including a small number of tragic cases where a patient has committed suicide"

Examples of cases settled by the MDU include more than £1m paid out to a patient with a history of depression who was left severely brain damaged following an overdose after being prescribed the antimalarial drug mefloquine; over £21,000 paid out to a patient who became addicted to an antidepressant; and a GP who missed a fractured hip in an elderly patient with depression after he visited the doctor following a fall. The patient received over £6,500 in compensation2.

In the article, Professor Oyebode highlights three main areas of risk highlighted when treating depressed patients:

- Problems with medication
- Failure to diagnose or treat an unrelated condition in a depressed patient
- Failure to recognise the risk of suicide in a depressed patient.

The article includes advice for GPs on how to avoid such problems. While some of these points may seem obvious, they are all examples taken from the MDU's files:

- Take care with prescriptions for drugs with similar names and with dosages, particularly with drugs that come in different formulae and strengths.

- Beware of the risk of drug interactions, for example between lithium and diuretics.

- Have a system in place to review patients on long-term medication.

- Be aware of the current guidance on the prescription of antidepressants.

- Ensure patients understand what is being prescribed and have been warned about the risks involved, any side-effects and alternatives to treatment.

- All patients who present with depression need to be assessed regularly for risk of suicide.

- Under shared care agreements, there should be a clear agreement on the responsibility for monitoring and treatment and the arrangements should be made clear to the patient.

- Be prepared to refer patients for specialist treatment where necessary and have a system in place to track referrals.

References

1. Medico-legal pitfalls in depression, MDU Journal, Volume 24, Issue 1, June 2008

2. All compensation sums quoted exclude legal costs.

The MDU - the UK's leading medical defence organisation.

Medical Defence Union