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Haslam's view: Reacting to matters of life and death

Isn't it strange how some deaths seem to be so much more important than others?

It happened more than 20 years ago, but I have never forgotten the tragic death of one of my patients. He died on the day of the King's Cross fire – a dreadful event in which 31 people perished.

The papers were understandably full of the awfulness of the situation. The Queen and the Prime Minister sent condolences to the families of the victims. The nation was united in its grief and sadness. And my patient's grieving and distraught widow suffered alone, with no condolences from anyone other than their closest friends, as he had simply died at home from a postoperative pulmonary embolus.

Her grief was as dreadful as any of the relatives of those who died in the fire, but for some reason our culture sees much greater tragedy if a number of people die together at the same time. I guess it's the same as the way in which road accidents kill far more people than plane and train crashes but never get the same headlines. You would have to be much more of a social scientist than I am to understand just why this is, but for the grieving relatives left behind it makes little sense at all.

Of course, my patient's pulmonary embolus was in itself just part of a mass of largely preventable deaths, but the whole topic of venous thromboembolism is rarely in the headlines, despite the carnage it causes.

Just look at the figures. MRSA is rarely off the front pages and kills 1,600 people a year. Venous thromboembolism kills more than 25,000 a year and rarely merits a sentence, let alone a headline.

The grieving experienced by the family, and the tragedy of a life cut short, is just the same. It's all so odd.

Recognising that much of life is odd, and perhaps inexplicable, is part of our role as GPs. I find it both fascinating and completely bizarre that while my first patient in morning surgery was someone who wanted a medical opinion after a mere 24 hours with a sore throat, the second was a man in his 30s who had been experiencing severe chest pain, with sweating and breathlessness, for the previous three days. He had put off calling a doctor as he ‘didn't want to be a nuisance'. His ECG confirmed that his pain was indeed cardiac, and he was soon bundled into hospital.

While we can understand why people behave the way they do – fear, denial, ignorance, wishful thinking – it is still completely fascinating that two individuals, so similar in age and education, living in the same area and presenting to the same doctor, should behave in such diametrically opposite ways.

And I will never forget a patient who most certainly didn't have a pulmonary embolus. I had initially suspected that he might, with his curious mixture of clinical signs pointing in that direction, and had sent him into hospital.

He remained an inpatient for two days and had every high-powered test known to medical science. Each and every test came back negative, and he was eventually discharged with the farewell words from a junior doctor ringing in his ears.

‘There was nothing serious,' he was told. ‘Your GP overreacted. You didn't need to be admitted at all.'

At least my patient thought this was funny when he came to tell, and thank, me. Medicine must be so easy when you can practise it in retrospect, mustn't it? Sheer luxury.


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

Recognising that much of life is odd is part of our role as GPs

Haslam's view

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