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