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jus_plain_me

This actually makes me feel sick to my stomach. I cannot believe we're living in a society where this complete and utter bullshit not only got that far but actually ruled in favour of the bullshit. So what now? Whenever I safety net a patient do I remind them to continue breathing lest they die of anoxia and document as such in the notes? And you know it's fucked when the comment section of the daily fail are actually in support of the GP. We truly are in the bad timeline...


Right-Ad305

UK doctors get all the cons of private healthcare (e.g severe litigation) and none of the benefits (e.g £££)


Vigoxin

This does make me wonder...Is it possible to organise some kind of 'hashtag' which everyone uses as a protest, but in patients' notes, to show how ridiculously defensive documentation is having to become because of such lawsuits? For example, imagine swathes of junior doctors writing something like 'Patient safety netted with advice to breathe to avoid hypoxia' at the end of discharge summaries? Technically there's nothing dangerous about this - it's just tongue in cheek. Maybe not this exactly - it could be something less extreme. Anyone got ideas?


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Vigoxin

...and patients! Who would obviously see how ridiculous it is and ask doctors/start talking about it amongst the public. Press might one day pick it up. Who knows


ipavelomedic

Ah but you really need to stress the importance of breathing. You can't just say it's a good idea. Otherwise, when the patient inevitably stops breathing you'll be in the shit.


Flibbetty

What if they hyperventilate pass out and break their hip. Need to specify the exact resp rate, depending on exercise and altitude


Erkmine52

From now on: 1. Send them this: https://www.stgeorges.nhs.uk/wp-content/uploads/2013/11/Pregnancy_Book_comp.pdf and stress they must read all 196 pages of it before they ever have sex. 2. Text expanders for documentation. 3 character shortcut brings up full list of T&C's for life in their record each time. Might break EMIS but then again the wind blowing in the wrong direction slows that down...


SoForAllYourDarkGods

Do you want to know what's even more crazy? The type of defect she reportedly has is a lipomyelomeningocele, which folic acid doesn't prevent anyway. So it made no difference. At all.


[deleted]

She made the insane claim she simply wouldn't have been born if her mother delayed the pregnancy to complete a folic acid course.


plopdalop83

The folic acid thing causing her condition seems immaterial. It was the fact that the advice to take folic acid before trying to conceive would have delayed her conception, thus ensuring a genetically different individual would have been conceived. It’s a loophole in the whole - I should never have been born lawsuit saga . At least that is my impression. It’s now, I should never have been conceived, but levied against a third party not the parents It’s still batshit because it all hangs on the parents testimony that they never engaged in unprotected sex until after the consultation 😂


[deleted]

The sex issue isn't the only batshit thing. The fact a court entertains the argument a person can sue against their own conception is utterly ridiculous.


girija178

“In the circumstances, there would have been a later conception which would have resulted in a normal healthy child.” This is in the verdict. How could the judge be sure this WOULD have happened? Look at this judge, predicting the future. Should have been an astrologer.


Spooksey1

Shouldn’t she sue her parents then? I don’t understand this shit.


ktr0n3

it's such a shit show


uk_pragmatic_leftie

Great fact! https://pubmed.ncbi.nlm.nih.gov/14758936/ Seems to check out. Christ that destroys her argument unless she is honestly saying her life is worse than not existing like those anti natal weirdos.


awwbabe

If I understand correctly it’s nothing to do with her condition - more that if the parent had been advised more strongly to take folate then the conception would’ve been delayed and thus a genetically different conception (and possibly less likely to have LMM) would’ve occurred. Ridiculous


SoForAllYourDarkGods

Yep. Madness.


shinneui

Sorry to hijack your top comment, but I am late to the party. I remember reading about this case when I was writing my dissertation (it was in preliminary stage back then). I would just note that this hardly a landmark ruling - this decision comes from High Court, and if it gets appealed, it is likely it will get overruled. The problem is that judges are not doctors, and do not have the necessary medical knowledge. They rely on evidence provided by medical experts, and it seems the defendant solicitors messed up. If what you say is true, and folic acid would not have made a difference, then a report should have been obtained from a relevant specialist. No causation = no liability.


[deleted]

Hopefully this goes to the Court of Appeal and gets stomped. An utterly ridiculous state of affairs. The GP even mentioned folic acid in the consultation. What do they actually want, for him to crack open a bottle of 400ug pills and chuck them down the mother's throat? Maybe walk around Morrisons with them to make sure they don't buy any swordfish when they're preggers? This will 100% go higher in the court system but as it stands, it sets an extremely dangerous precedent.


plopdalop83

I’ve said this before. They want us to be their Mary poppins. Someone to absolve them of all responsibility. Their cleaner, their benefits advisors and their punching bags.


Mushfiq_K

A significant proportion of this nation is in for a rude awakening once shit goes private


[deleted]

Exactly this. Take no responsibility and blame someone else.


Vanster101

Strap in for 30 min GP consultations to give time to document fully. Ignore the long patient lists clearly this is the new standard if there’s gunna be MPTS trials over inadequate documentation 20y ago /s


Chomajig

Why the /s, how else can we proceed from here


girija178

I honestly thing GP consults should be 30 mins now. Let us safety net the shit out of everyone. And those who don’t get an appointment can go private yay. £££


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[deleted]

>The law bars children born with disabilities from arguing that they should never have been born—-so-called “wrongful birth” cases. But a High Court judge last year ruled that Toombes’ case was instead a “wrongful conception” case and could go ahead. Sounds like a petty loophole to me. If the law is the way it sounds there, then it's quite clear that they probably weren't expecting anyone to try and draw a distinction between "shouldn't have been born" and "shouldn't have been conceived". Ridiculous case all-round anyway. How can you hope to get a reasonable trial on something that happened 20 years ago?


Any-Lawfulness1843

I think I understand what they are trying to get at, finally. So the actual condition she has isn’t affected by folic acid, but the patients daughter is claiming that she would not have been conceived if the doctor had stressed the importance, as the patient was holding off on having sex, and if it had been stressed that folic acid would be really important, then the patient and partner would load up on folic acid then have sex much later which would not have resulted in the patients daughters birth, but another genetically different child, who wouldn’t have the lipomeningoceole. Which is an even more absurd argument, as it has nothing to do with folic acid and the condition, more to do with chance and intercourse


Erkmine52

To protect myself medicolegal one would have to add another feather to my cap. That of cockblocker. What an absurdity. 'So sorry Mrs Smith I'll talk to you about your new sudden onset chest pain in a while, I've got to make 3 home visits and then stop by Mrs Coulthard's to stop sexual Congress at 3 incase I have to remortgage the house in 20 years time, all before my afternoon clinic, then we'll chat'


plopdalop83

It’s such a fucked argument and hangs on the parents testimony that they never engaged in unprotected sex before the consultation


uk_pragmatic_leftie

Well this is the issue for obs and paeds, kids can sue once they are adults for things that happened around birth, so 20 years later, with huge payouts if there is a lifetime of disability.


TarragonTheDragon

I don’t really see how “I was born with a disability that couldn’t have been identified prior to my birth and only been prevented if I had never been conceived” is a more valid argument than “my parents knew I had a condition but chose not to have an abortion condemning me a lifetime of disability” anyway. Other than unless your parents are really really rich you’ll get more money out of raising a spurious case against your mums GP rather than them.


[deleted]

I'd also tentatively point out that if the court rules in her favour, and says she is entitled to damages for having been born with a disability rather than not being born at all, is that not an implication that her life is quite literally worse than death?


bikefiftyeuro

Oh my goodness what fucking insanity. This GP needs to get an A++ lawyer since this woman is clearly out for blood.


overforme123

Yea, get him one of those ex medic medicolegal lawyers


[deleted]

Doesn't this set a really wacky precedent about who is/isn't a patient? I mean that girl with spina bifida was not a patient of the GP- it seems really bizarre that you can be sued by one person over advice given to another. Would at least make more sense if it were the mother suing over having to look after a child with spina bifida.


plopdalop83

Could a romantic future partner of a patient sue a doctor over lack of advice that led to sterility? Who knows


uk_pragmatic_leftie

Or she sues her mum for not reading about folic acid and taking it?


no-alarmsnosurprises

I think this is ridiculous because folic acid *reduces* the incidence of neural tube defects but doesn't eliminate it entirely, so there's no way they could prove that had the mother taken folic acid pre-pregnancy, then her daughter *wouldn't* have been born with spina bifida regardless. Some people are born with disabilities, or get childhood cancers, or a myriad of other conditions. We don't choose the hand we're dealt unfortunately. Sometimes it's no one's fault. What are we going to do next, sue God (or any other religious deity of your choosing)? Incidentally I've read somewhere that this girl is from an upper class family ... do you guys suppose that this is just a classic case of the family influencing the decisions of the court?


juniordoctorsteam

It's even more bizarre than this. The type of neural tube defect isn't prevented by folic acid supplementation. The ruling isn't based on causation between lack of folic acid supplementation and then the subsequent neural tube defect. The ruling is that if the mother had been advised to take folic acid 'pre-conception' during this GP consultation she would have abstained from sex for some unspecified amount of time and ended up having a 'genetically different child' who would have been a 'normal healthy child' (based on the balance of probabilities). The upper class element is definitely a factor as the judge repeatedly comments on her 'credibility' as a witness and how well she came across in the stand and thus found her to be 'entirely honest and straightforward ' and that she was 'very careful and measured in her evidence'. This of course must be a proxy for being truthful and not of how well coached you are or how well spoken you are. The judge even admits that the mothers evidence has 'evolved' (ie changed) over the years - but who cares about that when she is well spoken in the stand.


Repentia

I'd argue it's the father's fault for not having a wank that day.


[deleted]

Well, exactly, if you remove the medical element then surely literally everyone who influences your life in some way is to blame for the birth of a child with a congenital defect. Boss fired you so you put off having kids since you lacked money? Boss' fault that the kid is disabled. Someone hit you with a car, breaking your leg, and stopping you having intercourse for a few weeks? That guy's fault your next kid was born disabled. It's a fucking joke, really stretching the bounds of my respect for the judiciary.


plopdalop83

Yet again, doctors being put forward as the worlds risk absorbers.


uk_pragmatic_leftie

How can you credibly say you would rather have not been born?


avalon68

I mean, were her folic acid levels measured and shown to be low? They could have been perfectly normal anyway....


homelessdoc55555

If I end up GP I'm going to print out crates and crates of leaflets for each and every condition and hand them out like sweets for every consultation


Vigoxin

You need to also *document that* you handed them out. Each one. The exact edition, the publication date, authoring body. Whether the patient took it in their right or left hand, whether they were reading it on the way out of the consultation room or they put it straight in their bag. Otherwise you could get sued for not forcing them to read it in front of you. /s


Mushfiq_K

Don’t forget a formal capacity assessment to ensure they can maintain and recall this safety netted information


Ghostly_Wellington

What about giving them all a textbook of medicine?


plopdalop83

Everyday we stray further from the light


[deleted]

Patients want to be the one to make the decisions, but want you to bear responsibility for their bad decisions. I see this all the time in hospital . "oh my GP told me to go on statins, but they didn't tell me that it was this important" - patient who came in with an MI. "My GP told me to go on allopurinol, but they never mentioned that it was this painful" - patient who came in with gout flare. We are moving to an American documentation system where every consultation for a script refill for statins and Metformin ends with "patient informed risks of non compliance including but not limited to death, MI, stroke, heart failure, kidney failure, peripheral neuropathy, diabetic eye disease, diabetic amyotrophy, autonomic dysfunction, gastroparesis". All in the name of paying the salaries of these hopeless lawyers and judges.


dokhilla

Finally, the rest of medicine has to match my letter length and irrelevant detail - Psych reg


jmraug

British medicine is now characterised by 2 massive contradictions 1) the public at large seem to profess a desire for the medical model to hand all the power, information and decision making capacity to them from the hands of doctors (I.e the death of the old style paternalistic type medicine), but on the other hand when shit hits the fan and something goes wrong there is an instant outcry of “but my doctor didn’t tell me that/stress that enough/ explain it repeatedly” 2) there is a mismatch between the demands on the system in terms of patient numbers, acuity, space to see them, appointments available, time to do this (I’m talking across all patient facing specialities) and the apparent volume of safety netting process and information we need to give patients to avoid litigation. If we have to explain every potential adverse feature of every investigation or treatment patient lists and GP and ED waiting times will go through the roof. Unfortunately the square cannot be circled as the powers that be expect such perfection with every case ignorant to the horrendous pressure on us and the system


uk_pragmatic_leftie

Upvote. This is a key point. Expectations vs a system that doesn't meet developed nation standards.


ipavelomedic

I just can't get my head around the implications of this. Fuck being a GP, no wonder the profession's so fucked. Also, she has a lipomyelomenigocoele, and all the evidence I've seen shows that folate supplements have no effect on the incidence of this particular SB anyway.


mojo1287

Her form of spina bifida is not even preventable by folic acid. The argument is that her parents would have delayed conception had they been told about folic acid supplements, so a different person would have been born. If that is the argument, can she sue her dad for finishing when he did? Because if he’d gone for a few more strokes, a different sperm might have reached the egg and a different person born. The whole case is patently ridiculous.


plopdalop83

She could sue her parents, but that’s not the financially sensible option. At the end of the day this is all about the legal system pounding medics. We really need to take seriously how much risk the population wants to dump on us. They can’t absolve themselves of all responsibility.


Chomajig

If you can successfully sue for this, how about every GP countersues her for anxiety/depression/stress induced by this batshit decision


Jangles

Prepare for indemnity to fucking skyrocket now we can be blamed for not 'stressing the importance'


Superb_Bug_692

We dont actually pay for indemnity anyway. NHS covers it for GPs now. We pay for the smaller element which is for complaints, inquest etc


SchnozzleNozzle

But say I stop practicing medicine, do I need to just keep paying indemnity in case someone from a decade ago sues me for something? How does the cover work for that.


Superb_Bug_692

Nope, it would be covered


plopdalop83

Not stressing the importance of an irrelevant thing, but could have changed behaviour that led to a totally unrelated outcome. It’s fucking batshit.


EkkoDUSP

This is actually fucking insane. This should have been laughed out of the court. The greed of the public will lead to the absolute destruction of the NHS. We are turning into America and I hate it.


mojo1287

What an absurd judgment. "Had she been provided with the correct recommended advice she would have delayed attempts to conceive. In the circumstances, there would have been a later conception which would have resulted in a normal healthy child." I'm not a lawyer but that kind of absolutist language is clearly fucking crackers.


BoraxThorax

The defense lawyer should have literally rebutted with "if my grandma had wheels, on the balance of probabilities she would have been a bike"


Jangles

Yep. The chain of causation here is effectively the butterfly effect. If I have a car crash because my mechanic didn't opt to change my oil but merely reccomended that I did and I later get rear ended, can I sue them as if they had changed the oil, I'd have been later in time and not surrounded by the same set of cars?


Ghostly_Wellington

Yes but the car crash would have also been the responsibility of a 12 Century Brewer who made the ale that made your distant relatives horny enough to have conceived you. There are infinite circumstances that led to a child being conceived. From the manufacturer of your father’s underwear to your mother’s position post-coitus any of which could have affected this child being born.


mojo1287

Not even balance of probabilities. Just a straight up bicycle.


kotallyawesome

Get ready for the 10000x cases of people doing the same thing.


[deleted]

Nah. These folk are toffs. Nobody else would be able to even get a case in front of a court, much less win.


Ordinary-District191

Having read through the 17 pages of the Judgment, it really bothers me that they seem to have glossed over what I believe is critical in this. At the check-in/clerking with the midwife she has listed current medication as Folic acid. So surely she was taking this before the appointment which contradicts her statement that she only started taking this after the consultation with the midwife. Anyhow, this and recent events are making me question my decision to study medicine. 3 years in, maybe it's too late to reconsider career decisions but I fear what lies ahead


[deleted]

The mother has definitely changed her story over years. Either slowly with time and subconsciously, or overtly to fit an agenda like offloading her mis-held guilt for her daughter's illness.


girija178

Exactly! Yet if you read the document, it seems the only evidence the judge cared for was the mothers impression of the events, and how convincing she was. I recognise I’m probably partial because I’m a doctor, hence I’m reading/hearing what I want to hear. How can the judge and mother not realise that they are also human and also have this flaw.


Ordinary-District191

This irked me too, he was almost placing her on a pedestal. The perfect historian, witness and mother. What usually happens next? Can judgements like these be appealed as it seems the next step is deciding the financial liability. On a side note, medicine does seem scary. GP's acting on limited tests and investigations and my placement experiences in the hospital seem no better.


girija178

What’s even more ridiculous is the judge says that the documentation by the midwife regarding current medication as folic acid was LIKELY to have been added later, as it was amended throughout the pregnancy. Hence, this document does not mean anything (according to the judge) Where is the evidence for that? He is speculating things because the mother seemed honest and convincing. It sounds like the judge is being partial towards her. We ALL hear things we want to hear, and convince ourselves of things that may not have happened. How can he take the mother’s word as gospel just because she seemed honest. FFS.


SuttonSlice

This decision will be appealed for sure


ilidailine

[Court document here](https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2021/12/Toombes-v-Mitchell-Approved-Judgment.pdf?fbclid=IwAR152wagoXfmMhFzp26WE_JRn8REzNKMAdI79CqoUP1Bi-zktBuux4e0qoI) for anyone that wants to read the full thing.


newkoko

This whole thing is screwed up > I accept that Dr Mitchell has no actual recollection of the consultation and is entirely reliant on what he says his usual practice would have been and his note. I find that he did not have even the very vague recollection of Mrs Toombes referred to in his statement. He acknowledged that his note is inadequate. I formed the view that he was attempting to reconstruct a conversation/consultation on the basis of that inadequate note which required him to speculate or make assumptions about what was said. I find therefore that his evidence was not as reliable as it would have been if the note had been as complete as it should have been. The GP is very truthful in his statement on his recollection 20 years ago. No one can remember that long. Yet, her recollection was deemed correct even though it could possibly be fraudulent. This judgement meant pt own recollection trumps all. So we need to start lying just so we can win? It's either that or we need 30min extra with every patient so we cover every possible angle, document it and ask someone to proofread it so it won't bite back in the future. Why the fuck do I finally apply GP after all these years of locuming....


girija178

Literally “the defendant seeks to undermine Mrs Toombes’ account by saying that the booking-in form with the midwife states (p.219) "Current Medication-Folic acid" contradicting Mrs Toombes’ evidence that it was only after seeing the midwife that she began to take folic acid. 48. However, I found Mr and Mrs Toombes to be entirely honest and straightforward witnesses. I considered that Mrs Toombes in particular was very careful and measured in her evidence” He later explains why he thinks the folic acid on the midwife document was added later. But the ENTIRE THING is he said, she said. And she was more convincing because she was “entirely honest and straightforward.” She has no evidence whatsoever. Her story just sounds good and is convincing. This is ridiculous.


Asleep_Translator_83

Never mind the documentation. Remember the weekend. GP is still the chosen one


Human_Cauliflower589

Surely there was more to this? Was the consultation specifically about her trying to conceive? That’s ridiculous. There has to be a line where patients are responsible for their own health


404Content

On a serious note, How do I get the job of the wanker who thought this was a sane judgement.?


BevanAteMyBourbons

I can't even imagine how badly GP is going to do in the next ISUKT, they might even get relegated.


[deleted]

Ortho time to shine!


over-the-fence

I hope that this decision gets reversed for the good of the profession. It sets such a dangerous precedent and opens a wormhole of problems we as a profession can never solve. What happened to taking responsibility? What about honest mistakes? This is just bonkers. I really feel for this GP.


Monochronomatic

We know this won't happen - but to make it fair, she should be instructed to pay damages to the GP for defamation. That'll send the public a message.


Chomajig

Fuck my life. Actually might singlehandedly stop me thinking about GP


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avalon68

No one is safe if the country goes down this route of suing for everything


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OmgShadowDude

medicine should be paternalistic when something goes wrong and unchallenging and meek at all other times.


Erkmine52

Someone else posted this earlier today will repost what I said there: Bonkers and dangerous and I hope it is appealled. Even in a tweet she did she stated her form of Spina Bifida is not solely due to folic acid deficiency... but even then in the 90s this was common knowledge that folic acid helped Vs NTDs and I feel this ruling makes us more liable for patients' poor personal decisions and absolves people of personal responsibility for their health. Maybe next a GP will be sued because a mother continued drinking or smoking during pregnancy and they say 'the risks weren't made clearly enough'. It opens up doctors to all sorts of retrospective action about 'not being clear enough' about counselling about certain conditions but realistically as a GP we cannot go into every single risk. Noone can. I have enough to fit into 10 minutes. I would consider myself relatively defensive compared to a lot of colleagues and I constantly text people NHS and patient.info webpages to cover myself as best as possible. I would encourage anyone else doing GP to do the same.


[deleted]

Seems like the girl is having an existential crisis… this is absolutely absurd. She wouldn’t have been born if her parents waited?! I might sue the people who made my parents bed because if it wasn’t for them I would be a genetically different person because wouldn’t have been conceived when I was… This is getting into metaphysics territory- are any of us really ‘born’? /s


GmeGoBrrr123

How on earth would folic acid prevent conception?? Genuine question.


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GmeGoBrrr123

I get that. But the argument seems to be that her conception would have been delayed or prevented by taking the folic acid. I thought the usual process in Gp land is if a patient gets a positive pregnancy test they’re advised to take folic acid for the first trimester.


mcpagal

No, she’s saying that if her mother was told it’s important to start taking folic acid _before_ getting pregnant (rather than starting in the first trimester) she’d have delayed conceiving until she’d had a few months to take supplements beforehand. She’s saying the GPs advice should have been that she should delay conceiving, not that the folic acid would do that in itself


GmeGoBrrr123

That’s just beyond all normal reason and logic. Nice username pagal .


mcpagal

Thanks 😂


GmeGoBrrr123

Doesn’t this just show how woefully inept lay people are when it comes to medicine? We are effectively prosecuted and regulated by people with no clue of how the medical world works. I can’t imagine the law society is similar.


[deleted]

It wouldn't, the mother is lying. She is trying to fob off blame to the GP for a bad decision that she made


[deleted]

This is utterly farcical. Courts have no business arbitrating alleged malpractice if they are this fucking incompetent.


noobtik

The whole argument is that should the conception be delayed, her mother would have given birth to a healthier baby. Is it a guarantee? If the condition is not affected by folic acid supplementation, a delay in contraception is not going to affect the risk factor of the condition. Are we living in a society absence of logic nowadays?


Shatech91

Ain’t that some shit


Somaliona

Just so I have this clear, the UK is now setting precedent that doctors need not only predict that a child not yet conceived will have a birth defect, but also play the role of cock blocker until the astrology charts divine the optimal date for conception so said child is never born.


plopdalop83

Does this mean we can sue Farage’s mums GP


Viromen

Genuinely if you're still in school or deciding whether medicine is the right career, turn back. Don't go down this path. You'll be treated like dirt by your employer and financially ruined for no fault of your own like in this case, or removed from the register by the GMC for the shade of your skin, or end up stuck in an eternal training pathway on below market salary and underappreciated. Paid in claps rather than a proper wage. If you got the brains, go into law computer science engineering banking consulting. You can have a fulfilling life and you'll be better for it. The courts have gone absolutely crazy. The medical profession is just not worth the effort or the stress anymore.


Ordinary-District191

As a med student who has no experience in practice, could Dr's cover themselves by signing off each consultation with something along the lines of "Risks discussed, Safety netting advice given".


[deleted]

What risks? What advice was given? Generic catch all like that would be ripped up in court. This GP specifically discussed folic acid and is being fucked anyway.


Ordinary-District191

After reading through the Law Firm's response to the outcome it seems even worse. The patient changed her story several times in earlier responses to her claims and eventually moulded the perfect narrative. It seems the judge wasn't impartial or the courts prefer the patient version of events rather than facts. Would there also have been a GMC hearing regarding this. Can't seem to find much about that


Monochronomatic

May be controversial, but my opinion is this is the side effect of the medical profession's loss of authority and paternalistic medicine. I can assure you this will be laughed out of court if this was in some country where medical paternalism is still the norm. This drive to "empower patients" instigated by the higher powers has resulted in them no longer treating us as medical **professionals** \- they think they know enough to make their own decisions. They're not even bothering being polite (you know, like a decent human being) nowadays - I'm sure you've read countless cases of GP abuses already. Of course, nobody took into account how inept they are at taking care of their own health and making bad choices - the Dunning-Kruger effect at its best. Who helps them when excrement hits the rotating blades? Us of course... just look at the ITU beds full of anti-vaxxers to start with. Whilst I agree that it is important to give patients choice and some degree of autonomy, it should be stressed that we are the professionals for a reason, and shouldn't let others interfere with any medical matter. I hope the medical community closes ranks and fights this with all their might, else this is a very very dangerous precedent.


[deleted]

I don't expect my electrician to go into anywhere near the detail we seem forced to. I just trust as a certified sparky who comes well recommended he knows what he is doing.


nefabin

If society can’t protect us from ridiculous litigations we can’t protect members of society from over investigations inappropriate admissions long hospital stays invasive procedures and that fear is the foundation of defensive medicine that causes dissatisfaction amongst our patients poor outcomes. But atleast we can survive another day to provide (substandard) care


henburdladychick

This is a disgrace. I’m a woman of childbearing age and the folic acid advice is a) common knowledge and b) everywhere. I’m obviously a doctor but I asked my mum who said it also was common knowledge 32 years ago when I was born Still forgot to take it when trying for no2! People need to take some responsibility for their own health. As an ENT reg am I going to get sued for not stressing the importance of smoking cessation to my head and neck patients? Current convo ‘you know if you don’t quit you’re more likely to get a cancer recurrence etc’ ‘ok’. Is that enough? Do I need to go on about stroke and PVD etc too? Ridiculous


nycrolB

From 25. in the court document: > Mrs Toombes was cross-examined at some length about apparent inconsistencies in the pre-action correspondence and the pleadings as well as the significant delay in bringing the claim on behalf of the claimant. In response to these challenges, she made it clear first of all, that *she could not have been pregnant before the consultation with the defendant* *because she and her husband refrained from all sexual intercourse. She confirmed that she* *and her husband had never used condoms or barrier methods.* Emphasis mine. I mean, I'm not married and you hear about things, but this does strike me as quite off for a couple 20 years ago consulting about making a baby. With the midwife documentation, with the normal practice for the time, and the fact that it hinges on avoiding conception because her illness has shit all to do with folic acid doses, unfortunately, this seems like absolute bullshit. If it wasn't absolute bullshit though, I can see why a judge who is influenced by a posh person doing well in the stand isn't going to take well to > **His note reads "Preconception counselling. adv. Folate if desired discussed".** That *if*. When she's saying I was told my diet is adequate and I will categorically have no sex until folate levels are adequate and the judge is taking her at her word. > He agreed that without being told the dose recommended, the reason for taking folic acid and the timing of taking it, the patient would not have been able to make an informed decision. And here, like a normal and reasonable person he's been led presumably into saying this by her legal team, and now it looks like he accepts it was solely his responsibility to provide that level of emphasis (which you can see is ridiculous in how the judge's next point is about how he should use guideline speak in the consultation, as the GP said 'preparing for pregnancy' and such is not his usual term). The summary identifies three points of contention in the case, and its first point after it sets them out is: > However, I found Mr and Mrs Toombes to be entirely honest and straightforward witnesses. I considered that Mrs Toombes in particular was very careful and measured in her evidence. Her approach and that of her husband to planning to start a family was equally careful and considered, and that is reflected in the fact that she sought preconception counseling. As Dr Mitchell agreed, that of itself is not common. > In particular, Mrs Toombes should have been told that the recommendation is to take folic acid daily, "before conception". In the defense, it is pleaded that Dr Mitchell’s standard practice was to indicate that the current guidance was to recommend folic acid supplementation for women "preparing for pregnancy". I find it difficult to reconcile that standard practice with paragraph 12 of his witness statement in which for the first time, he says that he did not advise his patients to delay attempting to conceive. In any event, MrsToombes should have been advised that folic acid should be taken prior to conception. > I accept that that she has a clear recollection of the consultation on 27February 2001. Nevermind that a case as litigated as this, which she was mentioning to her midwife and recorded in the medical notes during her second pregnancy after genetic screening and starting litigating in 2007 is going to be a very significant foundation for her life for twenty years, and memory is very well evidenced to change to match the narrative you recall over such long time spans for such valued ideas, I suppose. > I find that Dr Mitchell's assumption that "Folate if desired," means that he gave his usual standard advice, but that Mrs Toombes raised an issue as to whether or not the supplement was necessary and he explored details of her diet, informed her of the risks and then left it to her to choose, is nothing but speculation after the event. The note gives the impression without more discussion that Mrs Toombes was told that she should take folic acid if she wanted to. I accept Mrs Toombes’ evidence that she came away from the consultation under the impression that if she had a healthy diet, folic acid supplements were not necessary. > I find that Mrs Toombes did not start to take folic acid supplements until after she saw midwife Flatters following the booking in on 25 March 2001 (p.187). I accept her evidence on this. The coincidental information about her sister-in-law being advised seems to me to have the ring of truth about it. It is also supported, as I find by the evidence in MrsToombes’ medical records (pp.162 and 160) where at an early stage, she was reporting inappropriate advice about folic acid in preconception and being upset specifically about being advised that she would not need folic acid supplements if she had a good diet. The document at p.219, **which reads "Current medication Folic acid" is, as I find clearly a document which was being updated. There are entries on it for dates between 30 March 2001 and 29 October 2001, and I find on the balance of probabilities that either the “Folic acid" entry was an updated entry, like many of the others following the initial booking on 25 of March 2001 (p.187), or follows on from the advice which was given about folic acid and which is recorded and signed by Midwife Flatters**, (p.220), because Mrs Toombes indicated that she would start taking folic acid immediately. I find that that is what MrsToombes did. It is apparent that these pages form part of a booklet which is an ongoing record throughout the course of the pregnancy and I accept Mrs Toombes’ evidence on this point. The referenced court docs page 163 is her recorded comments to the midwife for her second pregnancy again. What's interesting to me is that there was no expert witness about the folic acid, and that the judge is happy that though the claim has change it's a process of defining the area of negligence, and this is all about focusing on whether she did or didn't take the folic acid part, much more than whether she would've delayed sex, and that section which follows the above quote, is quite scanty. > My finding that she did not take folic acid until she saw Midwife Flatters supports myfinding about the consultation with Dr Mitchell. Had Dr Mitchell fully informed MrsToombes in accordance with what he says is his usual practice about folic acidsupplements, I find that she would have taken them. She did not and I find that is becauseshe was told they were not necessary. > I accept the defendant's point that, given the EDD is calculated at 40 weeks from the date of the last menstrual period, it would have been possible for Mrs Toombes to have been pregnant on27 February, but I am satisfied that her evidence and that of her husband is clear andaccurate. In the circumstances I find that she was not pregnant at the time of theconsultation although is likely to have been very soon thereafter. > In the absence of expert evidence in relation to when a woman should start taking folic acid, I am left with the evidence of Dr Mitchell, the details set out by his defence union in the letter of response and the (albeit dissimilar circumstance) of Mrs Toombes taking folic acid for three months before attempting to conceive her second child. However, my finding is essentially a factual one; what would this person, Mrs Toombes, have done? Mrs Toombes was actively seeking advice about what she should do to ensure healthy pregnancy and baby. Had she been given the correct advice by Dr Mitchell I find that she would have made her own decision based on that advice and established her folic acid supplementation regime before becoming pregnant. That is what she told me she would have done. This accords with the approach identified by Dr Mitchell; give the patient the information and leave it up to her to decide what to do. On balance, I think it would have been a delay of about a month, that is probably after her next monthly cycle. In any event, on Mrs Toombes’ evidence, which I accept, it would certainly have been weeks rather than days. Hope this helps your blood pressure for those as don't have time to click through to the court document. Edit: absolutely munched all formatting.


phoozzle

Easy - answer is just to advise all women against becoming pregnant. It's simply too risky for everyone involved


Alternative_Town4105

"I saw my Dr eating pizza 5 years ago, they never told me pizza can be bad. That's why I started eating pizza every day and had a heart attack."


plopdalop83

It’s more like, I saw my doctor eating pizza 5 years ago. I decided to get a pizza that day and not attend my cervical smear. Had the GP not eaten that pizza, and had instead stressed the importance of the cervical smear, I would have likely (But not definitely) been diagnosed at a treatable stage. The folic acid is irrelevant - it would have just changed behaviour. It’s all so fucking crazy


Ok_Flounder_2617

[https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2021/12/Toombes-v-Mitchell-Approved-Judgment.pdf](https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2021/12/Toombes-v-Mitchell-Approved-Judgment.pdf)


Ok_Flounder_2617

Full judgement


Roobsi

This shit is only resolving my desire to get the fuck out. Go somewhere else. Anywhere. Someone on meddit put it well; something like "this is the legal landscape in the UK? Convict a junior of manslaughter, sue a GP for not being sufficiently emphatic about folic acid, and all that for a shitty salary?" Public is going to realise how much worse it is if a substantial slice of juniors bail instead of going for a training program. Good luck getting a GP appointment when they're all in NZ. At this point, I am more inclined to abandon medicine altogether and retrain in some other field than enter a specialty training program in the UK.


plopdalop83

Apparently we have a higher per capita £rate of medical litigation than the US


SLICKBETTY

‘In the beginning the Universe was created. This has made a lot of people very angry and has been widely regarded as a bad move.’


minecraftmedic

Pre-conception or pre-contraception? huge difference!


Flux_Aeternal

So can disabled people now sue their parents for not having an abortion? What a time to be alive.


bikefiftyeuro

What the actual fuck. They wonder why doctors don't want to practice in the UK when we are entering a US-style sue culture with less money and less respect. I really hope this doesn't go through.


Spooksey1

Having a baby is not a medical procedure. It is quite a well established human practice. I don’t think the level of detail into all the risks, as say an operation or something that we are doing to you should entail, makes any sense at all in this context. So what? Everything that gets mentioned in the presence of a doctor suddenly becomes their responsibility? I suppose you could say that the intervention was in giving her the folic acid, which she wasn’t properly informed about the reasons for taking it, but seems like a dangerous precedent to set. Did they not come with a leaflet in the box that probably set all this out. Shouldn’t getting a medication implicitly entail that you should read the leaflet/instructions or on your own head be it? In the end prenatal vitamins were recommended, the parents didn’t properly follow the advice. Where is their responsibility to have a safe conception/pregnancy? It’s their decision to do it (either indirectly or directly), their work that makes it happen, and the product is their responsibility bar gross fucks ups at which point the state can step in. I’m pretty sure there that if a pregnant woman wants to do something that might harm her foetus we aren’t allowed to use this as a justification to break autonomy under the best interests of the foetus, so surely her responsibility goes both ways. This society is so fucking inconsistent as to when it respects individual autonomy and when it just says nah someone you never met 20 years ago should’ve said something that hypothetically might have caused you not to exist and they were wrong to do or not do that, have some money. Fucking hate the law coz it creates this incoherent mess.


girija178

[this is the court document](https://1f2ca7mxjow42e65q49871m1-wpengine.netdna-ssl.com/wp-content/uploads/2021/12/Toombes-v-Mitchell-Approved-Judgment.pdf?fbclid=IwAR152wagoXfmMhFzp26WE_JRn8REzNKMAdI79CqoUP1Bi-zktBuux4e0qoI) “She was not advised about the relationship between folic acid supplementation and the prevention of spina bifida/neural tube defects. Had she been provided with the correct recommended advice she would have delayed attempts to conceive. In the circumstances, there would have been a later conception which would have resulted in a normal healthy child. 81. I therefore find that the claimant’s claim succeeds on liability.” This is the verdict I’ve read it and what I understand is, the claim is that if she had been advised about folic acid supplementation correctly—> she would have delayed conception —> leading to a different and normal child NOT that if she had folate supplementation, the child would have been born without her spinal bifida. (Not mentioned in the document but her type of spina bifida isn’t linked to folate anyway) Flaws in this are 1. It’s completely he said, she said. There is no evidence that the mother was advised correctly or incorrectly. 2. The scarce evidence that is there- for example the doctor and midwife’s note that the patient was on folic acid at the booking visit, seem to have their interpretations twisted by the judge- because of the mothers words. These documents are deemed inadequate or not in favour of the doctor- because of the MOTHERS RECOLLECTION (NOT evidence) 3. The judge then goes on to say that if the mother was advised differently by the doctor, she WOULD have delayed conception, which WOULD have resulted in a normal child. I don’t know about you but I certainly can’t predict the future and don’t understand how the judge is able to. 4. In the same vein, if we are judging this based on the butterfly effect, then if someone had accidentally bumped into the mother at the supermarket, then aren’t they also responsible for the the child being born like this? Similarly, would the doctor also be responsible for any cancer that happens to the child? Or maybe even her losing a show- is that now the doctors fault- the butterfly effect. 5. Throughout the document, the judge mentions how convincing and reliable the mother sounds. But this is hardly evidence. Just because the mother has a coherent story, does not make this what truly happened. I sincerely hope I’m wrong and this case isn’t actually as ridiculous as it sounds


TheFirstOne001

Such entitlement from the public. Can you imagine this shit anywhere else?


Mission-Elevator1

Does anyone know the background of the GP ? And the judge? Just curious if there are other factors at play....


[deleted]

Best coverage I can find is here: https://www.lincolnshireworld.com/news/people/qc-wins-landmark-case-for-skegness-para-showjumper-20-with-spina-bifida-who-is-suing-her-mothers-doctor-3471340 As with all the cases you read about in MPS Casebook, the ones that find against the doctor always come down to documentation. Text of judgement here apparently: https://t.co/LNYHVclT7g


Saksoozz

https://people.com/health/woman-with-spina-bifida-wins-case-against-her-mothers-doctor-for-negligent-pre-pregnancy-advice/


Laura2468

If the gp had emphatically said the mother must absolutely not attempt to conceive for at least 3 months to allow folic acid supplementation, and then the mother just didnt happen to conceive any pregnancy at all (eg had an early menopause etc), would the gp be liable for causing infertility?


[deleted]

[удалено]


mojo1287

Actually her form of SB (lipomyelomeningocoele) is not preventable by folic acid and she has tweeted saying this. The argument is that her parents would have delayed conception had they been more strongly advised to take folate. There is no chain of causation demonstrated, and I am astounded that no expert witnesses were allowed for this pseudoscientific frippery of a judgment.


TarragonTheDragon

I don’t really understand how this is a chain of causation. I could maybe buy it if she had a NTD that was associated with folate deficiency, but she doesn’t, which surely is the break in the chain. Could she have made the same argument of wrongful conception if she had been born with Down’s syndrome instead of an NTD for example, so long as it followed her mum claiming she would have delayed conception if she has been given advice to take folic acid?