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Independents' Day

A serious case of being misled


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Case presentation time.

Case one. A 38-year-old man with a ‘chest infection’. 

Case two. A 45-year-old man with ‘really bad hay fever’.

Case three. A 78-year-old woman with ‘tonsillitis’.

Those diagnoses in quotes are all incorrect, by the way. They were the patient’s self-diagnosis, which I always make a point of contradicting, mainly on principle, but also because they’re nearly always wrong. As they were here. The correct diagnoses were, respectively, a pneumothorax, cardiomyopathy and leukaemia.

Surprised? I was, but not that much. I didn’t make the specific diagnosis is any of these recent cases. I’m only a GP, right? But I did spot that something was definitely amiss and acted accordingly – disposal not diagnosis, is the key, as any fule kno.

This is one of the safety nets the public is in grave danger of losing

Now, I’m not trying to be clever here. No cleverer than the average GP maintaining the average level of consciousness through the average day duty surgery, anyway. There were clues in each case, after all. In the first, no cough but plenty of breathlessness. In the second, severe, unexplained dyspnoea, with no wheeze, out of proportion to his hay fever, plus it’s not spring. And the third? Well, 78-year-olds don’t get tonsillitis, do they?

And there was one other significant clue for each case – the records revealed they were all very rare attenders. Which in itself, rings klaxon-decibel alarms, even in mid day-duty stupor.

This is something we GPs are pretty good at: being able to spot the pathological needle in the haystack of trivia. And this is one of the safety nets the public is in grave danger of losing. As the obsession to provide a drive-thru, all you can eat, 24/7 NHS continues, overstretched services have to give somewhere. Which means that safety net will develop some significant holes – because the punters will be seen by doctors who are knackered, disinterested or distracted, who may be unfamiliar with them or their records, or who simply may not be doctors at all.

Result? The rare and serious masquerading as the common and trivial will be missed. Does the public accept this inevitable trade-off? Has it been asked? And will the fury of the mismanaged be as great as the gratitude of those who were spotted early? Because, if so, the Government’s new indemnity bill may be bigger than it’s anticipating.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield



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Readers' comments (6)

  • One of my patients was an old car mechani. He lamented the loss of subjective experience in diagnosing problems with cars and then repairing the relevant parts. Nowadays everything is diagnosed by computer and there is significant subspecialization among mechanics. Very few general mechanics are left. Diagnosis is made by computer. The relevant faulty part is removed and the new or renovated one is bolted on. In the old days the mechanic would repair the faulty part by taking it apart. Those days are completely gone. Unfortunately healthcare is going the same way. So personal medical experience is going to mean less and less. Every patient will be put through a batch of tests according to the AI computer generated algorithm, requiring multiple investigations. The problem with carrying this out now is that these investigations and tests are very expensive. It’s not like switching on the car computer, once the mechanic has the necessary software. My feeling is that investigations for humans will become very much cheaper and health care will ultimately go the same way as the maintenance and repair of cars. The job will become even more unpleasant. In fact there will be no need to employ doctors. All the intelligence will be done by computers and lay people will be trained just to perform specific tasks. Sad world…

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  • I don't like the term 'chest infection' on principle, as it ranges in possibility from shingles, breast abscess, osteomyelitis of the ribs, empyema, pneumonia, bronchitis, pericarditis, myocarditis, endocarditis, spinal abscess, and probably many more.

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  • So spot on. Completely agree Tony!

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  • The FATPOA induced complacency of GBP with regard to healthcare provision will be suddenly replaced by wailing and gnashing of teeth when reality strikes (and it won't be long now).

    What's truly remarkable is the paucity of reporting in media e.g. What will the outcome of GMC v MPTS in High Court on 7/12/17 be?, what will the outcome mean for the medical profession?, and what will the outcome mean for medical provision and patients?

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  • After 35 years, I could fill a closely typed A4 sheet with diagnoses that presented as 'backache'. Would be impossible to even begin thinking about an algorithmic approach to just this one symptom. Tony is so right about the 'rare visitor' red flag.

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  • Agree.

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