Confessions of a GP - Benjamin Daniels [64]
The cockup and up shit creek
Some time ago I saw a woman with some odd tightness in her chest. She was well in herself and only in her mid-fifties. She told me that she had the symptoms when she went into town shopping and wondered whether they might be due to anxiety. I asked her lots of questions about the pain to make sure it didn’t sound as if it was because of problems with her heart or lungs. I also gave her a thorough examination, but couldn’t find anything wrong. I had a long chat with her about relaxation techniques and breathing exercises and told her to come back if the pain got worse. Three days later she collapsed with a heart attack. Again I had missed the diagnosis, but sometimes heart problems can present oddly and perhaps many other doctors would have done the same as me. In hindsight perhaps I should have done a heart scan and ordered some blood tests but these might not have made a huge difference. My real error in this case was that my documentation in the notes was really poor. I didn’t write much about the pain she had or the examination I did. Legally, I hadn’t covered myself at all.
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