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At the heart of general practice since 1960

Pulse survey may shape GPs' future

lack of visit

for father's

death

Mr Smith is a patient who rarely bothers you. One day you receive a phone call from his daughter to say he is 'not right' and is 'feeling under the weather'.

She asks whether you could call in one day this week as he rarely gets out.

She says there is no rush and that you can check him over as a routine visit. You make a note to pop in later in the week.

Two days later an angry daughter is at the front desk, shouting so that everyone can hear, saying that it's all your fault her father is dead.

What do you do next?

There is clearly a very immediate problem. Try to defuse it before it escalates out of control. As a first measure I would go to reception and ask the woman to come into my consulting room. If my room is not free, I'd go to the practice manager's office or a spare consulting room. It may be wise to ask for another person to 'sit in' and corroborate anything that is said.

I would adopt a non-confrontational approach. I would ask the daughter to sit down and explain what has happened. I would offer my condolences for her loss.

It may be her anger is part of the grieving process and it is important to allow her to

express her grief and listen to her story.

Offer her practical comfort too, such as tea and tissues.

With luck, as the story emerges you will feel able to put her angry outburst in its true context. Maybe the daughter is also feeling guilty for not having sought more urgent medical attention or for not having provided more for her loved one. A further meeting with other members of the family may be appropriate.

If the daughter is still unhappy or angry at the end of this process you could inform her of the local complaints procedure. But hope that this will not be pursued. My own experience is that an early meeting when I say I am genuinely sorry without accepting any blame has helped defuse several potential complaints.

At a practical level it will be necessary to determine who, if anybody, has certified death and whether you will be in a position to issue a death certificate. If Mr Smith hasn't been seen for over two weeks a phone call to the coroner is mandatory.

As I usher Mr Smith's daughter into a room where the patients cannot hear, I make a mental note never again to agree to 'just pop in and see' a patient after a relative's request. I now realise that by agreeing to pop in later in the week I may well have unwittingly accepted responsibility in his daughter's mind for her father's medical problem, without knowing any details.

In future I will ask the relative (who I may or may not know) to write down what their concerns are, to scan this into the medical records, and say I will decide what to do once I have studied this information. Thus I can assess whether the problem is acute or chronic and I can make a plan without agreeing to a visit at the outset. For medicolegal reasons I would make a computer entry in the patient's records.

As Mr Smith rarely gets out 'these days', it seems he is not housebound, and in the future I would write to the patient stating that his daughter is concerned about him (thus avoiding any conspiracy) and would he arrange to come to the surgery to discuss any problems he has.

If possible I would arrange for blood tests such as FBC, TFT, and glucose before the consultation.

Back in the private room, I will try to stay calm with Mr Smith's daughter and understand the facts from her. If she has just found him dead at home, I will need to certify death and contact the coroner. If he has been taken to hospital then I need to contact them as soon as possible.

Once the details are clearer I can speak to the daughter again and explain what is going to happen next. In my own mind I know that the death was unexpected and that I did nothing wrong, but angry relatives are not good for waiting rooms!

Oh dear, this is a no-win situation! Justified indignation will get you nowhere, and nothing you can do or say will change the poor daughter's belief that you are responsible. Patients like a bit of drama, and you can be sure this will be telegraphed around the area before you can say postmortem.

The first thing to do is to calm the situation. The poor woman is feeling grief, guilt, anger and confusion; it is just unfortunate that you are in the firing line.

It matters not a jot that your notes will show the casual nature of the original request and your intention to visit; the fact remains that if you had seen him, he might not have died.

At this stage there is no point in arguing your case; your protestations would fall on deaf ears. Better to be sympathetic and just swallow it down, but don't grovel ­ that will reinforce your guilt, and no logic will

persuade the daughter otherwise.

You will be feeling embarrassment, injustice and probably a sliver of responsibility, but be kind to yourself. You know what went on, and you did nothing reprehensible; you can't be all things to all people all the time.

The postmortem will reveal the cause of death, and at this point it would be worth contacting the family to talk through what went on. With a bit of luck things can be explained in simple terms and your reputation will be salvaged.

More likely though, even having accepted that it wasn't your fault, you will be inextricably linked with the death in the family's eyes, and your relationship with them permanently altered.

Such is the lot of the family GP ­ learn to take it on the chin or retire now.

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