Confessions of a GP

As you can see, these three cases are all mistakes of sorts and could have landed me in trouble. As you can also see, the degree of the mistake doesn’t always correlate with the amount of harm that comes to the patient. I have learnt a lot from them and I am a better doctor as a result. The near miss with the blood transfusion was probably the most negligent on my behalf yet as by pure good fortune no one came to any harm, I got away with it completely. Had things turned out differently, I could have been struck off and, much more importantly, the patient could have died.

Missing the brain tumour was the least negligent because I really did do a thorough well-documented history and examination. For the lay person reading this, you may feel that I should have sent the patient to have an urgent brain scan. Unfortunately, I don’t have access to brain scans. My only option would have been to have sent him straight to A&E. As with most GPs, I probably see about 200 people per year complaining of a non-complicated headache. If all GPs sent all of these patients to A&E, the system would collapse. The wife of the headache man is considering suing me. I’m a little anxious about this, but I know that I am completely covered because I’m fairly sure that if 100 GPs read my notes, most of them would have done the same thing as me. I felt dreadful when I found out that I had missed that brain tumour, but without X-ray vision, I don’t think I could have been a better doctor that day.

Mistaking the chest pain for anxiety was similar to the headaches in that it was a difficult diagnosis to spot. However, if the patient had wanted to sue me she could well have been successful. I wrote so little in the notes from that consultation that if she had claimed in court that she had all the classic symptoms of a heart attack or angina, then I had nothing in writing to defend myself. Medico-legally if it isn’t written down, it hasn’t been done. Shortly after the heart attack, the patient came in with her husband to see me. They were angry and upset and wanted to know why I had missed the diagnosis. I made the excuse that it was sometimes difficult to spot heart-related chest pain, but ultimately I held my hands up and said sorry. The hospital cardiologist had fortunately told them that her presentation of heart pain had been very unusual and as he knew me from my days in the hospital, he backed me up by telling them that I was a very good doctor. As far as I know, my apology was enough and they are not planning any legal action.

If I miss a diagnosis, the patient suffers regardless. But from a legal view point, irrespective of how excellent and thorough I was in the consultation, if I’ve not documented my findings, I may as well not have seen the patient at all. I see up to 40 patients per day so can’t remember each consultation. Court cases often come up years after the incident occurs and the medical notes are often the only thing the doctor has to defend their actions. If something goes wrong, the patient will probably think that they have a vivid recollection of the consultation, but often the details of the event can change as the memory is recalled time and time again. An example of this is when a patient says, ‘That Dr X told me I had a year to live’ or ‘The A&E doctor said I would never have children.’ First, doctors rarely commit to these sorts of bold statements and second, when I read the notes from those consultations, the documentation tends to be very different from the patient’s recollection.

It is quite hard for a doctor to admit mistakes and I think what I’m trying to say here is that although I’m not the best doctor in the world, I’m mostly quite a good doctor. Mistakes happen to all of us. I try my best each day to avoid missing any serious health problems but I have made mistakes in the past and undoubtedly will make them in the future. My only other option would be to refer every headache I see for an urgent CT scan and every chest pain to A&E for a hospital admission. Perhaps in an ideal world I would do this but the NHS wouldn’t cope with the strain and it would also cause unnecessary anxiety to many well people.

Some mistakes are genuinely because of negligence by poor doctors. Most mistakes are made by good doctors who perhaps missed a difficult diagnosis or didn’t write enough in the patient’s notes. I hope we don’t become like the USA where ambulances are chased by lawyers hoping to persuade unwell people that it could be their doctor who is to blame for their illness. On the other hand, were it my family member who was ill or dead because of a possible medical error, perhaps I would want some justice too.

Dying