Medical Council hears consultations took ‘approximately 10 minutes’

A doctor who was working for an on-call GP service told a fitness-to-practise hearing of the Medical Council that he was expected to complete consultations in approximately 10 minutes.

The doctor, Gustavo Granados Paucar, has been found guilty of poor professional practice in relation to his care for the late Thomas O'Callaghan, whom he called to see on the evening of Monday, May 6th, 2019.

Mr O’Callaghan, who was 92 at the time, died the following Saturday in St Vincent’s Hospital, with a blocked abdomen. Dr Granados had diagnosed gastroenteritis and prescribed medicines for nausea and stomach cramp.

“I love my job,” the doctor, who is originally from Peru, told the council hearing. “I am determined to learn from this one-off event.”

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The committee upheld complaints from Mr O’Callaghan’s daughter, Lorna O’Callaghan. It is to produce a report on the case including in relation to sanctions.

Physical examination

The hearing was told Mr O’Callaghan had become unwell and that his daughter, Lorna, had gone to the house to help her mother. That evening they called the doctor on duty service linked to her father’s normal GP. Dr Granados arrived by car.

During a visit of between five and 10 minutes, Ms O’Callaghan said, the doctor did not physically examine her father’s abdomen, did not directly address her father, and did not explain what the medicines he prescribed were for until she asked him.

“I was a little shocked afterwards,” she said. “He was gone and then I realised, my goodness, I was almost no wiser than before he came.”

Neasa Bird, for the council, said Ms O’Callaghan had complained about five aspects of the visit, including in relation to communication and diagnosis.

Ms O’Callaghan accepted that a different diagnosis would not have altered the ultimate outcome for her father, but it would have saved him from the “severe pain” he suffered on the Monday night.

Standard of care

Dr Granados did not give evidence but in a statement accepted four of the five complaints. He said he could not remember the visit but that the notes he had made two days later indicated that he had conducted a physical examination of Mr O’Callaghan’s abdomen.

He said he wished “to sincerely apologise to Ms O’Callaghan and her family. I am sorry that the standard of care afforded to her family that night fell short of the standard of care to be expected and of the standard that I normally set for myself.”

It was not an excuse, he said, but it was important to consider the pressure he worked under when considering the delay in writing up his notes.

“We were given approximately 10 minutes to complete a consultation and encouraged to get to the next appointment without delay.”

He has, he said, since completed courses to improve his English language and communication skills.

Tom Fahey, professor of general practice with the Royal College of Surgeons, said he believed the five matters complained of constituted poor professional performance. He said he believed Dr Granados was "under time pressure" and "wasn't thinking adequately".