Further Confessions of a GP

If anyone asks me the worst thing about being a doctor, my answer is always immediate: for me, it’s the constant fear of making a mistake. Every July a letter from the General Medical Council falls on my doormat. It is always a request to renew my annual subscription, but without fail, when I see who the letter is from, my heart races as I wonder if this could be the summons calling me to explain my incompetent actions to a courtroom full of grieving relatives and snarling journalists. It’s a fear that never goes away. It is something that every doctor has to learn to live with.

I was once three days into a holiday in Mexico when I woke up in a cold sweat, terrified that I had forgotten to do something for a particular patient sitting in a hospital ward 5,000 miles away. I couldn’t go back to sleep until I had called the ward to make sure the patient was okay. I was genuinely worried about that patient, but I can’t deny that there was a large helping of self-preservation in my fear. Making a mistake could cost me my job. Still, despite the general consensus that doctors are only in it for the money, we do care about our patients, and the idea that someone could come to harm because of my error is horrifying.

A surgeon knows that if he accidentally snips an artery when trying to remove a kidney the patient could die within seconds on the table in front of him. As a GP my mistakes are less acutely dramatic, but the potential consequences of my actions could be just as grave. Any headache could be a brain tumour, any feverish child could have meningitis and, as I discovered last year, any cough could be lung cancer.

Last April Ted came to see me with a bad knee. We had a chat about painkillers and I referred him to a physiotherapist. As he was leaving he asked me if there was anything I could do about his smoker’s cough. I suggested he gave up smoking, and he shrugged and walked out the door. Eight months later he was admitted to the emergency department with a collapsed lung due to lung cancer. When I looked back at the medical notes I made at that last appointment with me, I hung my head in shame. I wrote plenty about his knee pain and then at the very end it read: ‘Cough. Smoker. Advised to stop smoking.’ That was it: I hadn’t listened to his lungs, I hadn’t asked about weight loss or coughing up blood, and I didn’t request the chest X-ray that might have diagnosed his cancer earlier and saved his life. I even looked through the notes of some of the other patients I saw that afternoon. I spent nearly 30 minutes talking to a 20-year-old law student about her numerous self-diagnosed food intolerances, yet when Ted told me about his cough, I short-changed him with just a few seconds of my time.

I was dreading seeing Ted again when he came into see me after his diagnosis. However, when I apologised for not picking up his illness earlier, he laughed. ‘Dr Daniels, it was me who smoked all them cigarettes for all those years. I can’t blame you for me getting this disease. I was dreading coming in to see you as I thought you’d be cross with me for not taking your advice to give up the fags sooner. I was expecting you to say “I told you so”, not “I’m sorry”!’

I tried to explain my culpability: ‘But if I had sent you for a chest X-ray sooner, the cancer might have been curable.’

Ted gave me a generous smile. ‘Don’t blame yourself, Doctor. I don’t.’ With that, he left. Despite his generous forgiveness, every time I saw Ted I was awash with guilt.

There is a bad joke about doctors being able to bury their mistakes. This wasn’t the case with Ted. I saw him at work, but I also bumped into him in the supermarket with his wife. I even spotted him at the football with his grandson. It was as if he was everywhere I looked, and each time we met, his obvious deterioration was a reminder of my error. Even now that he has died, Ted’s wife comes to see me regularly. She remains oddly trusting of my medical opinion and completely unaware of the massive guilt that bubbles to the surface of my consciousness with her every visit.

The fear of making a mistake is indeed a terrible part of being a doctor, but on reflection actually making a mistake is truly the worst part of the job.

Should we name and shame doctors who make mistakes?

I’m not the only GP to have made a mistake; compensation payouts for medical negligence are going up, not just the number of cases but in the cost of the payouts. As a way of combating this, it has been suggested by the government that doctors should be named and shamed by publishing our mistakes and performance data online. The idea is that this will allow patients to choose their GP based on his or her track record, and that the resulting possibility of losing ‘customers’ (patients) will motivate us to improve.