Topic: Renal Biopsy Lost
Subject: Surgery

Door Tablet Information

OPENING SCENARIO

You are an FY2 in Urology Department where John Smith, a 27-year-old had been referred by the GP. The diagnosis of Poststreptococcal Glomerulonephritis has been made. It was decided by the nephrologist to do a kidney biopsy. Renal biopsy was performed, and the specimen was taken 2 days ago. The patient is back for the results. You called the laboratory to try to find the specimen and enquire about the renal biopsy report. The laboratory informed you that the specimen was never received. The hospital has been searched thoroughly but the specimen hasn't been found. No valid reason found for not getting the sample. Please talk to the patient, disclose the situation, and address his concerns.


PATIENT INFORMATION

You are a 27-year-old, John Smith who is here for the renal biopsy report. You had been having high blood pressure and swelling in your legs. You had also noticed blood in your urine. You had a sore throat 3 weeks ago that was cleared with Amoxicillin. You have no history of kidney disease or a family history of kidney disease.



Medical error cases in PLAB 2 usually tend to come with the new findings after previous laboratory tests or imaging studies were reviewed by a junior doctor and the patient was sent home and then upon review by a senior doctor, the results are found to be an error. In this particular case, the laboratory test was not actually done, so there is no missed diagnosis because of misinterpretation of the results, rather the missing sample. To do these cases well in PLAB 2, in addition to the interpersonal skills of apologizing, incident reporting, root cause analysis meeting discussions, and offering PALS to the rightly upset patients and relatives, it is good also to do a complete history about what happened before the event, including past medical history in chronic diseases that present with an acute exacerbation or serious complication, and what happened after the event, or the complications that may be related to the delayed diagnosis and proper management. It is important to explain what should have been done if the error did not occur, for the apology to be heartfelt, and how this may contribute to delayed recovery-and what is going to be done now that the error has been discovered-and what chances of improvement or prognosis there is. This will include the follow up plan and safety netting to be put in place to ensure the best outcome.