The commonest reason for women being prescribed contraception to make a complaint or compensation claim against their doctor is the development of a recognised complication such as a deep vein thrombosis, pulmonary embolism or infection.
A review by the Medical Defence Union (MDU) of over 150 cases related to contraception prescribed mostly by GPs between 2014 and 2016, has found that in 30 cases the patient alleged she developed a known complication. Other reasons for cases included mixing up the names of a commonly used contraceptive injection with a steroid injection leading to a medication error, contraceptive implants being incorrectly sited and a failure by the doctor to exclude pregnancy before prescribing contraception.
Dr Beverley Ward, MDU medico-legal adviser, explained:
‘Contraception is a very common reason for women to consult their doctors, and in most cases, there are no problems. However this analysis demonstrates that there are risks involved in prescribing contraception, and in a few cases patients can come to harm.’
She continued: ‘It is essential that doctors providing these treatments to mostly young and healthy patients, bear in mind the risk of complications. It’s also important for doctors to ensure they are appropriately trained and regularly update their skills, especially when performing invasive procedures such as inserting contraceptive implants.’
The MDU analysed 161 complaints, compensation claims and other medico-legal queries relating to contraception. Most cases involved GPs (72%) or other general practice staff (19%), with the remaining cases involving hospital doctors and consultants.
In a small number of cases, patients complained about the doctor’s unprofessional attitude, illustrating the sensitive nature of the discussions necessary when patients request contraception.
There were 48 compensation claims, with many relating to contraceptive implants and 67 complaints, the highest number relating to the contraceptive pill or patch. In the remaining cases doctors needed general medico-legal advice or help with other incidents.
The MDU advises that by following a few basic principles doctors can help to minimise contraceptive prescribing risks. These include:
Discuss carefully with patients what treatments are available, and in particular the risks and side effects of each when getting consent.
Ensure that you are appropriately qualified in prescribing and performing any invasive procedures.
Take care when administering injections to check the label carefully to prevent the administration of an incorrect drug.
Take a careful sexual and menstrual history. This is important to assess the risk of an existing pregnancy before you provide contraception.
Handle discussion of past history with sensitivity, expressing the need to ask personal questions.
Document the discussion and ensure that the patient is aware of and understands the associated risks.
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