Confessions of a GP - Benjamin Daniels [63]
I am very pleased to say that this sort of thing only still occurs in a very few practices and is being clamped down on. Our PCT has learnt a few tricks from the drug companies. We are still bribed to prescribe certain drugs but it is now the PCT that does the bribing. The practices in our local area are given targets to prescribe the cheaper drugs and if we hit the targets, we earn financial bonuses. This may seem crazy but the PCT have realised that for some GPs the only way to ensure that our drug spending is kept down is to reward us financially. The money they pay us for hitting the targets is nothing compared to the money saved by the NHS if we prescribe the cheaper generics. Yet again it feels embarrassing that doctors need financial incentives to prescribe sensibly.
Mistakes…I’ve made a few
I think medical errors can broadly be divided into four categories:
Type 1. The near miss: Making a mistake but it doesn’t actually cause any harm to the patient.
Type 2. The cockup but arse covered: Missing a diagnosis and the patient comes to harm. However, the diagnosis was hard to make and the doctor did all the right things and documented this very well in the notes.
Type 3. The cockup and up shit creek: Same as the last category, but as well as missing a hard diagnosis and the patient coming to harm, the doctor didn’t document things very well in the notes.
Type 4. The probably in the wrong job: Making a completely unforgivable mistake that can’t really be excused regardless of the documentation. This might include refusing to examine a patient or repeatedly missing a really obvious diagnosis.
Thankfully, I have never made a mistake in type 4 and hopefully never will. To be fair, I actually think they are incredibly rare.
Unfortunately, I have made mistakes in the first three categories and although nobody really likes talking about their own mistakes, they are probably fairly typical of slip-ups made by young doctors like me so I thought you might find them interesting.
The near miss
As a very junior doctor I was on a ward round with my consultant and a final-year medical student. The consultant said that he wanted a transfusion for Mrs X and asked me to take some blood to send to the lab so that we could confirm which blood group she was.
After the ward round, I asked the medical student how confident he was in taking blood. He was happy to give it a go, so I asked him to go off and take some blood from Mrs X. He came back proudly ten minutes later with the blood and I labelled the forms and samples of blood and sent them to the lab. The next morning as we got to Mrs X on the ward round, she was sitting happily in her bed with her second bag of donated blood running through into her vein. My medical student suddenly turned very pale. ‘Is that Mrs X?’ he trembled. ‘She’s not the lady I took blood from yesterday. I took blood from that lady opposite.’
Now this could have been an absolute disaster. Giving the wrong blood group to a patient can make them very ill and potentially kill them. I had signed the form stating that the blood taken was from Mrs X and therefore would have to take responsibility for the error. The medical student should have checked who he was taking blood from but ultimately, I was responsible for supervising him so again the buck would have to stop with me. Fortunately, Mrs X and the patient from whom my dopey medical student did take blood had the same blood group so no harm was done. I plucked up the courage to tell my consultant what had happened. I was fully expecting the shit to hit the fan, but instead he stuck a fatherly arm round my shoulder and said, ‘Don’t worry, Ben, I made far worse mistakes when I was a junior. You got away with this one, but just make sure you learn from it and don’t let it happen again.’
The cockup but arse covered
I saw a middle-aged man complaining of headaches. His headaches were fairly nondescript with no symptoms of weakness in his limbs or problems with his vision. He hadn’t banged his head and the only thing of note was that he