The stain of inadequate communication

The aspiring professional ballet dancer 

GP consulted by a 21-year-old female experiencing fatigue and overall low energy for some time. The patient was enrolled in a Bachelor of Fine Arts (Dance) degree.  

Patient expressed strong concern about her symptoms and asked many questions about what might be wrong with her health. As an aspiring professional ballet dancer, she mentioned her dancing routines demanded long hours of training, and that her body, looks and appearance on stage were very important to her. Thus, looking tired and pasty was undesirable. 

GP ordered a blood test and results showed a mild iron deficiency. The patient expressed relief it wasn’t too serious and mentioned that she wanted to resolve it quickly, so she could return to her dancing training routine and feel her normal self again. 

GP recommended the option of an iron injection, as they are more effective than oral tablets (both in time and degree of increase) in improving ferritin levels over 30 days. The GP explained that the injections can be delivered intramuscularly (IM) or intravenously (IV) and that the IM option was associated with pain and possibility of skin pigmentation. The other alternative was to take iron tablets. 

The patient elected to proceed with an IM iron injection. The injection was administered by the practice nurse following the full explanation of the right Z-track technique by the GP. 

A few days later, the patient rang the practice asking to speak with the GP. She had developed pigmentation over the injection site, and she wanted to pursue a claim. 

Reason for complaint, claim or investigation 

Development of a permanent skin stain at the site of IM injection. The patient alleged the injection technique used by the nurse (under supervision) was not correct and/or it was not correctly administered. She also alleged that the iron injection was an unnecessary and incorrect treatment. Even though she accepted that the risks had been explained to her prior to the injection, she alleged that the option of IM injection should not have been given. 

Clinico-legal knowledge 

  • Materials risks 
  • Informed Consent 

Questions to ponder 

  1. What were the materials risks involved in this case?
  2. Was the informed consent conversation appropriate? Should it have included the nurse who performed the injection?
  3. Would it have made any difference to the ‘informed consent’ conversation if the patient had not been a stage performer? 

Relevant MBA code of conduct skills and competencies 

4.3 Effective communication 

4.3.4 Discussing with patients their condition and the available management options, including their potential benefit and harm and material risks. 

4.3.5 Endeavouring to confirm that your patient understands what you have said. 

4.5 Informed consent 

4.5.1 Providing information to patients in a way they can understand before asking for their consent.