A specialist Warfarin care service owes a duty not only to manage dosages but also to advise the patient and their GP of persistently sub-therapeutic levels and associated risks, and to recommend investigation of alternative therapies in consultation with the patient's treating specialist. The content of this duty is determined by the court, not solely by expert evidence of professional practice. Where a trial judge makes findings on the balance of probabilities that a chain of hypothetical events would have occurred (advice given → referral made → treatment instituted → injury avoided), this is not a loss of chance claim but a conventional causation finding subject to the 'all or nothing' rule. The prospective assessment required by Vairy v Wyong Shire Council applies to breach of duty, not to the assessment of the likely chain of events after the breach.
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