Avoiding Errors in General Practice

Kevin Barraclough is General Practitioner, Painswick Surgery, Painswick, Gloucestershire

Jenny du Toit is General Practitioner, Painswick Surgery, Painswick, Gloucestershire

Jeremy Budd is General Practitioner, East Quay Medical Centre, Bridgwater, Somerset

Joseph E. Raine is Consultant Paediatrician, Whittington Hospital, London

Kate Williams is Partner, RadcliffesLeBrasseur Solicitors, Leeds

Jonathan Bonser is Consultant in the Healthcare Department of Fishburns LLP, Solicitors, London, and former Head of the Claims and Legal Services, Department of the Leeds office of the Medical Protection Society

Contributors

Preface

Abbreviations

Introduction

Part 1 The legal structure of negligence

A few words about error

Medical negligence

Learning from system failures-the vincristine example

Causes of diagnostic errors in general practice and how they can be avoided

How do general practitioners reach diagnoses?

Where do errors occur in diagnosis? 

How can we minimise the risks of these errors?

Further reading

Bayesian reasoning and avoiding diagnostic errors     

A potpourri of advice on avoiding errors

The history and examination

The telephone consultation
 
Communication problems

When lack of knowledge plays a part

The unexpectedly abnormal result

The standard of notes

Drug or prescribing errors   

Consent

Conditions that are “frequent flyers” in negligence cases

Safety netting

Further reading and references

Part 2 Clinical cases

Introduction

Case 1 A man with iron deficiency

Case 2 When is a headache abrupt?

Case 3 A woman with chest pain

Case 4 A dizzy man

Case 5 Rectal bleeding in a pregnant woman

Case 6 A pulled calf muscle

Case 7 A woman with hemiplegic migraine

Case 8 Irritable bowel syndrome after sickness in Goa

Case 9 A young man with back pain

Case 10 Irregular intermenstrual bleeding in a woman on the Pill

Case 11 A boy with a limp

Case 12 A runner with a cough

Case 13 A woman with classical migraine

Case 14 A young woman with diarrhoea and vomiting

Case 15 Ill-fitting dentures in an elderly man

Case 16 Back pain in a middle-aged woman

Case 17 Cellulitis in a man’s foot

Case 18 A flare-up of ulcerative colitis

Case 19 A woman with a skin lump on her leg

Case 20 A woman with microscopic haematuria

Case 21 A limping young girl

Case 22 A builder tripping over his feet

Case 23 An anxious young woman with
hyperventilation

Case  24 A slightly raised AST in an Asian woman

Case 25 Cough and fever in a 42-year-old accountant

Case 26 Lost prescription: benzodiazepine addiction

Case 27 A febrile baby

Case 28 A limping elderly woman after a fall

Case 29 Indigestion in a stressed executive

Case 30 A hoped-for pregnancy

Case 31 A breast lump that disappears

Case 32 Fever and cough after an ankle fusion

Case 33 Urinary problem in a welder

Case 34 A hypertensive 38-year-old woman

Case 35 A swollen lip in a 56-year-old man

Case 36 A woman with fatigue and weight gain

Case 37 A woman told off for ignoring her friends

Case 38 A man with a headache: swine flu or meningitis?

Case 39 A woman suffering dizziness

Case 40 A middle-aged man with an ankle injury

Part 3 Investigating and dealing with errors
Introduction

How errors and their recurrence are prevented in Primary Care

The Role of the Primary Care Trusts

Other investigations

Legal advice – where to get it and how to pay

External inquiries

The role of the doctor

Emotional repercussions

Conclusion

Index

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