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January 23, 2024

Revamping Rheumatology: Addressing Concerns and Improving Patient Care

darry robinson

DARRY ROBINSON

The Health and Community Services, Government of Jersey issued a report prepared by the Royal College of Physicians (RCP) on 22nd January, including findings relating to the review of patients who received rheumatology care between January 2019 and December 2021. 

The RCP found the standard of care to be well below what the review team considers acceptable for a contemporary rheumatological service. Several areas of concern and potential areas for improvement were identified by the RCP review including:

  • Little evidence to support a relevant history having been taken, and in particular a lack of reference to disease activity scoring. Without documentation of disease activity, it was difficult to understand the extent of patient’s disease and therefore justifications for treatment.
  • No evidence of clinical examination and little evidence of standard immunological investigations giving rise to the potential for inconclusive diagnosis having been given to patients.
  • A lack of relevant imaging to support diagnoses. For example, the review team found in several cases patients were diagnosed and started on medications without a magnetic resonance imaging (MRI) scan having been conducted to confirm the diagnosis.
  • Limited, and often absent, handwritten evidence of the clinical interaction with the patients. The professional opinion for each case was documented in a typed letter. These letters were brief and generally uninformative. They often failed to mention the diagnosis, rarely mentioned any relevant clinical findings and lacked therapeutic information, past or current. Due to this, the review team found it difficult to understand the clinical decision making.
  • Despite a lack of clear diagnosis, biologic agents were prescribed, with frequent and multiple changes. For example, a case was reviewed where a patient had been diagnosed with Inflammatory arthritis (IA) although an ultrasound scan had shown no evidence of active synovitis. Despite this, the patient was started on treatment with biologics.
  • In the majority of cases reviewed, patients were often initiated on biologics and switched therapies frequently without having an adequate time to determine efficacy. In some of the cases patients were treated with five or more biologics within a short period of time and in many cases prescribing was outside both UK and European guidance.

The RCP felt obliged to write an interim letter to Dr Patrick Armstrong, medical director (dated 24 March 2023) expressing a view that the two consultants should not work independently in providing rheumatology care until such time that the review and other local processes were complete. In addition, a recommendation was made for an audit to be commenced of those patients currently on biologics to assure that their diagnoses were secure.

The RCP review will no doubt result in consideration of legal proceedings by persons who received rheumatology care during the relevant period.

Benest & Syvret are committed to assisting any person injured as a result of medical negligence. If you have been effected by any of these matters, contact Darry Robinson on 875875 or via email  info@benestsyvret.com to discuss a potential compensation claim.

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