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Ignorance doesn’t listen to experience

I have just had one of my most unpleasant experiences since becoming a GP in 1988.

An infrequent surgery attender appeared on a booked 10-minute slot incandescent with rage. He perceived me to be an uncaring, incompetent doctor who had failed to diagnose that his elderly, asthmatic mother was seriously ill with pneumonia, claiming that ‘anybody could have known’ and that her life had been put at risk.

The actual sequence of events was that a home visit had been made to assess severe neck pain and general malaise in a 78-year-old, asthmatic woman with two previous spinal operations and pneumonia in 1991, four days into a course of clarithromycin.

An assessment including vital signs, full examination and pulse oximetry was carried out, and after 20 minutes it was agreed this woman – who was speaking in full sentences and did not want to go to hospital – would remain at home under the care of her live-in daughter and be reviewed in the light of a pending chest X-ray result.

Advice was given to call again should there be vomiting, difficulty breathing or carer worry.

A script was issued for additional analgesia for the neck pain. Six hours later the daughter called out-of-hours, channelled through 111. The telephone triage flagged up possible ‘crushing or severe aching/pain in the chest, upper back or upper abdomen’ and an ambulance was despatched. The subsequent diagnosis was bi-basal pneumonia not apparent on chest X-ray but revealed on CT scan, in the face of persistent fever and very elevated CRP.

The son had no time for any explanation, either of the difference between an experienced GP’s home visit and a protocol-driven telephone triage service, nor of the fact that diseases evolve, and left grimly shaking his head.

He was not planning a formal complaint because of the ability of the medical establishment to close ranks and cover things up. Dr Roger Neighbour would have lamented lack of ‘housekeeping’ and that the remaining patients were kept waiting for over half an hour.

From Dr Nicholas Ford, Croydon, south London