Confessions of a GP - Benjamin Daniels [65]
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
Our frequent close proximity to death and dying is perhaps one of the features that sets doctors apart from people in other professions. For most people, death is fairly sanitised now. It is rarely seen in its gritty reality and many people of my generation will never have seen a corpse or even somebody very ill. The constant exposure to something that most people would find very shocking can’t help but take its toll on your personality and outlook on life. Of course, we don’t suddenly acquire these characteristics upon passing our final medical school exams. Death and dying become gradually normalised as we are processed through the system of medical school and our first hospital jobs as junior doctors. In our very first week at medical school, we were cutting up corpses in the dissecting room. This was partly to learn anatomy, but also an attempt to give us an early exposure to death and help us learn to distance ourselves from it emotionally. I know that I must have normalised dying in my head because, although I have seen hundreds of people die, I can only actually remember one or two of them. Perhaps I’m particularly callous or have an exceptionally bad memory, but as I’m sitting here now racking my brains, I can recall very few of the names or faces of patients whom I have watched breathe their last breath.
Although I now feel very unsentimental towards death, the first patient that I watched die is etched very strongly in my memory. I can picture her face very clearly and I can even remember her name but I’ll call her Mrs W. She was an ordinary 60-year-old woman who had woken up as normal that morning. She had felt fine and had been getting herself