Daughter Angry That A Locum Missed Her Father's Fracture — Free SCA Practice Case

Character Overview: You are Sonia Eccles, 55, calling by video from your kitchen on your lunch break. You are the daughter of Alfred Sedgwick, 82, a retired railway signalman and a widower who lives alone about twenty five minutes' drive from you. You work as a debt adviser at a Citizens Advice office and you are used to dealing with complaints yourself, so you know how to be firm. Your father has been a patient at this surgery for forty years. Eight days ago he tripped on an uneven paving slab in his garden and landed on his right hand. He went to the surgery by himself, because he hates a fuss, and saw a locum. You were not there. You only have his version. He was told it was a sprain and sent home with a bandage. Five days later his wrist was bigger and he could not grip a kettle, so you took half a day off and drove him to A and E. He waited nearly six hours. An X ray showed a broken wrist, and he now has a plaster to the elbow. You are furious, tearful at moments, and fast talking. Under the anger you feel guilty that you did not go with him, and frightened that your father is slipping. You are polite and clear, not abusive. You calm down only when you feel properly listened to and given straight answers. You cannot be fobbed off with leaflets or phrases like "I understand your frustration".

Opening Sentence: "Thank you for seeing me. I'm ringing about my dad, Alfred Sedgwick. A locum told him last week that he'd just sprained his wrist, and A and E have now found it's broken. I want to know how that happens, and honestly I want that locum struck off."

History if Asked (Data Gathering Phase)

• ●What happened at the first appointment: "I wasn't there, so this is what Dad told me. He was in and out in about five minutes. The doctor had a quick look at his wrist, pressed on it, moved it a bit, said it was a sprain and gave him a bandage. There was no X ray and no one said anything about one. He said the doctor was perfectly pleasant, he just didn't seem to stop and think."
• ●The fall: "He tripped on a loose slab by the back step, about eight days ago. He put his hand out to save himself. It swelled up that night. He said it was a bit sore and he'd see how it went, and then he went the next morning."
• ●How he was in between: "He took paracetamol and kept the bandage on. He said he'd been told to come back if it wasn't better, but he didn't want to be a bother. By the fifth day it was twice the size, bruised right down to his fingers, and he dropped a cup trying to lift it. That's when I took him in."
• ●A and E: "Two days ago. They did an X ray and said there's a break at the wrist, on the thumb side. The doctor said it hasn't moved out of place. They put a plaster on up to his elbow and told him to go to the fracture clinic. That's in three days. Nobody there said whether the week's delay mattered, and I didn't think to ask."
• ●How he is now: "He says it aches, about a four out of ten, and he takes paracetamol. His fingers are a bit puffy but he can wiggle them and they're pink and warm. No numbness, no tingling. The plaster isn't tight."
• ●Why he fell: "Just the slab. No dizziness, no blackout, no chest pain. It's the first fall I know of for years. His knees are bad and he's not quick on his feet."
• ●Whether anyone else has been told: "No. I haven't told anyone but my husband. I haven't contacted the GMC yet but I've looked up how to."
• ●Her father's wishes (give only when asked): "He knows I'm ringing. I asked him this morning and he said I could talk to you about his wrist, he's in the lounge now. But he doesn't want a complaint. He says doctors are busy and everyone makes mistakes. I think that's the old school in him."

Ideas, Concerns, Expectations

Gating note: Sonia does not volunteer the following. Each part comes out only when the doctor asks what she thinks happened, what is worrying her, or what she is hoping for.

• ●Ideas: She thinks the locum was careless and rushed, and did not take her father seriously because he is old and polite. She is sure an X ray should have been done and believes the week's delay has made the break worse. "If he'd been fifty and shouting, they'd have sent him for a scan."
• ●Concerns: She is frightened her father will not recover full use of his hand, will lose his independence and end up needing care. She feels guilty that she did not go with him. She also worries about how many other older patients get a five minute appointment and a bandage. "He's all I've got left of my parents."
• ●Expectations: She wants the locum struck off, or at least stopped from seeing patients. She wants an honest answer on whether a mistake was made, an apology, and to be told what will actually happen. She wants it in writing. She does not want to be passed to a call centre.

If Asked: Medical History and Medications

• ●Medications: "Amlodipine for his blood pressure and paracetamol. Nothing new."
• ●Health generally: "Blood pressure, bad knees and he's a bit deaf. His mind is fine. He does his own crossword and his own money."
• ●Bones: "No one's ever mentioned his bones. His mother broke a hip in her eighties."
• ●Capacity and decisions: "He makes all his own decisions. He was very clear this morning."
• ●Phone calls: "He can't hear on the phone, which is why I do the talking. He's perfectly fine on a video call with the volume up."

Social History and Lifestyle Impact

Actor guidance: Volunteer these naturally if the conversation allows.

• ●Your mother, Pat, died three years ago. You are an only child and live twenty five minutes away. Your husband works shifts.
• ●Your father lives alone in the house you grew up in. He has refused a pendant alarm twice. He does his own shopping and cooking, and with the plaster on his right hand he is struggling with buttons, the kettle and the stairs. You have been going round every evening this week and it is wearing you out.
• ●You took half a day of leave for A and E and you are behind at work. Your manager has been understanding but you cannot keep doing it.
• ●You have helped clients make complaints at Citizens Advice yourself and know that people are often fobbed off. That is why you ask for things in writing.

If Asked: Associated Symptoms

• ●Pain in the plaster or other limbs: "Only the wrist. He hasn't hurt anything else."
• ●Fingers: "Puffy but pink, warm and moving. No numbness."
• ●Other bruising or injuries from the fall: "No. His knee was a bit scraped, nothing more."
• ●Head injury, fainting or dizziness: "No, none of that."
• ●Low mood or eating: "He's quieter than usual and says he's a nuisance, but he's eating."
• ●Other falls recently: "Not that I know of. He says he's fine."

Responses to Management (The Negotiation Phase)

• ●If the doctor listens, apologises for the experience and does not blame or defend the colleague: Your anger drops a notch. "Thank you. That's the first time anyone has said sorry. I'm not out to destroy anyone's life, I just want someone to take it seriously."
• ●If the doctor defends the locum, says these fractures are easily missed, or says the locum is a good doctor: Sharp and angry. "So that's it, is it? You lot stick together. I'd like someone to tell me whether a mistake was made, not a speech about how hard your job is."
• ●If you ask directly whether it was a mistake and the doctor gives an honest answer that the wrist was found to be broken after being called a sprain, that the practice will look into why, and that they will be told what is found: "That's an honest answer. Thank you. So who actually looks into it, and will I be told what they find?"
• ●If the doctor says the locum will be struck off, or cannot be: If promised: "Good, so he'll be gone by the end of the week?" If told it is not the practice's decision: "So who decides? Can I report him myself? And if I do, does that stop the practice looking into it?"
• ●If the doctor explains the practice complaints process: "In writing to the practice manager, then a letter back? How long? Who investigates, and will it be the same doctor marking his own homework? And if I'm not happy, where do I go?" Accept the ombudsman as the next step.
• ●If the doctor raises your father's consent, or asks to speak to him: "He's in the other room. Dad, the doctor wants to check you're happy for me to talk. Yes, he says that's fine for his wrist, but he still doesn't want a formal complaint. He says I can say what I like if I leave him out of it." If the doctor explains that the practice cannot discuss his records or act on his behalf without his say so: "Fine, I'll talk him round. Can he sign something? Or can he tell you himself?"
• ●If the doctor offers a check on your father and a review of his falls and bones: "Yes please. Nobody has said anything about his bones. Will you ring me, or him? He can't hear on the phone."