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Haslam's view: Moments when life changes forever

All too frequently days end in ways that one never envisaged.

Indeed, sometimes the direction that our lives take feels as clearly predetermined as the toss of a coin.

When people ask me what I write about, the answer is usually ‘about 700 words a week', but when they more accurately focus on where I find a source of topics to write about, the answer is simple.

After all, one of the joys of general practice is the almost never ending supply of stories that our patients, and our colleagues, bring into our lives. And I've always felt that you don't have to be solemn to be serious.

Some years ago, I remember watching a film called Sliding Doors starring Gwyneth Paltrow and John Hannah. The plot centred on the theory that there are moments in life when the future forks in totally different directions – half the film told the story of Paltrow's character after she managed to get on an underground train and get back to her flat to find her boyfriend in bed with someone else, and half the film told the outcome of her failing to catch the train.

It was a great plot device, but it was fatally flawed. It isn't just the single moments when everything is up for an alternative future – it's every moment.

I am constantly struck by how much our patients' lives can change in a moment. Different destinies can revolve around the most trivial of differences.

Those occasions when we remember to take the blood pressure in an asymptomatic patient, discover that it is sky high, and prevent the stroke that may have been scheduled for a later appearance in their life, happen all too frequently.

And then there are the patients whose days start without a care in the world, and end with a road accident that leaves them disabled for life.

There are patients who consult us having no idea that their symptoms are serious, and who are suddenly sent travelling down a road of investigations and therapies that change their lives forever.

There are the pregnancies that are unexpected and bring great joy. There are the pregnancies that are unexpected and bring despair.

Life has a remarkable habit of dealing unexpected hands. And there are those moments that have the potential to change a doctor's life forever too.

Those occasions when a small inner voice suggests that you take a symptom more seriously than you had maybe initially intended, leading to a diagnosis that could have been missed with disastrous consequences.

There are the occasions when you decide to visit, rather than advise, and realise how close you might have been to a major error.

I often look back with a shiver on how close I may have come to getting a case seriously wrong. For instance, the time I decided to visit a patient rather than offering advice by phone and finding that he had meningococcal septicaemia. I shudder to think of the terrible impact it would have had - for everyone - if I had not made that visit.

There are the occasions when you decide to visit, rather than advise, and realise how close you might have been to a major error


Professor David Haslam CBE
GP, Ramsey, Cambridgeshire; President, Royal College of General Practitioners; national clinical adviser to the Healthcare Commission; and Visiting Professor at de Montfort University, Leicester

Professor David Haslam

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