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Your first... missed diagnosis

The blow of a missed or delayed diagnosis hits hard so it's important to have a coping strategy, advises Dr Stephan Cembrowicz

The blow of a missed or delayed diagnosis hits hard so it's important to have a coping strategy, advises Dr Stephan Cembrowicz

Doctors find mistakes and complaints painful to deal with. Nobody is 'superdoc', and GPs see pathology in its earliest, less-recognisable stages. You will not spot all disease as soon as it appears. So how should you deal with a diagnosis made later than it could have been?

First, don't overlook intuition and gut feelings when dealing with patients. Let a casual mention of weight loss or constipation in an older patient, or funny headaches that have got worse lately, ring alarm bells or raise the hairs on the back of your neck. Use time actively to allow symptoms to emerge – and keep clear records.

Your patient is less likely to blame you if you have remained on their side and you have been looking at an undiagnosed problem together. Make it implicitly understood that patients should return to see you if, in the ancient phrase, symptoms persist.

Second, how well you and the patient are able to deal with a serious problem depends on the relationship you have had previously over more minor matters. If you have seemed dismissive, rushed, or abrupt when presented with early symptoms you are more likely to be criticised later. An established sound working relationship will help negotiate unexpected bad news later. This is not defensive medicine.

Third, an honest explanation at an early stage is usually the best policy. Phoning or visiting someone after they have had a hospital admission that you did not predict, for example, is good practice. If you were mistaken, or their clinical condition was not apparent when you saw them, an explanation, an expression of sympathy and where appropriate an apology early on (which costs nothing) will help resolve matters.

If you make a diagnosis that another doctor has missed, perhaps enjoy a private moment of intellectual superiority – but avoid the temptation of implying criticism. This could sour your subsequent working life together. General practice involves seeing early pathology before signs have polarised. Your partner needs to know if they missed something so be sure to let them know.

When another doctor has been careless or even negligent you are in a more difficult situation. You have to protect patients from carelessness or worse. If you are concerned about a colleague's competence, enlist the support of allies – such as your partner or a young principals group, and use this network for advice and support.

In an extreme case involve the LMC or your defence society, which will have seen it all before. They will advise if the authorities (such as the PCT or even GMC) need to be informed. Again, keep clear records.

Learning from events: missed diagnoses and mistakes can be put to good use as material for significant event analyses. Review the circumstances around an incident where outcome was not optimal, and consider the various factors contributing to that outcome. When used to improve the system, these exercises can be enjoyable learning aids.

Stefan Cembrowicz is a GP trainer in Bristol

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