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Dropping the ball: a case of ‘missed’ diagnosis



When the woman started shouting, ‘I expect you’re really happy that he’s got a tumour, aren’t you?’ across our crowded waiting area, I was a bit taken aback. Mainly because I had no idea who she was, and in part because I had absolutely no idea who she was talking about.

Turned out that when her brother-in-law (who I had seen once in my life a few months earlier) was leaving my consulting room, she overheard me say something to the effect of, ‘And if you go and get an eighth opinion about your stomach pains, I’ll nail your head to the wall’, guess what? He did.

He’d seen every doctor in the place and hadn’t stuck with any one long enough to let them do their job. It might make a difference to the outcome, it might not, only time will tell, but if I’ve learned anything during my climb up the greasy pole, it’s that the most effective way to delay an important diagnosis is to bunnyhop from consulting room to consulting room along the way.

Honestly, I don’t mind giving second opinions. I don’t mind being the “go-to” guy when patients reach their ‘three strikes with the same symptom and you’re out’ limit with the nurses and registrars, and are told to go and see a ‘proper doctor’.

But I really don’t like being the seventh person someone decides to tell about their diarrhoea, dizzy spells, dysuria or depression – especially when Doctors 1-6 have all tried their hardest to get the diagnostic ball rolling, done all the right things (though not necessarily in the right order). Most would have been on the point of figuring it all out when the patient decided to jump ship and start again with the doctor in the next room along the corridor.

I’ve got a selection of cookery books on my kitchen shelf and each of them has the author’s fail safe recipe for scrambled eggs. And I can say that they all work. Delia, Gordon and Jamie can sort out whose is the best in the car park mano-a-mano if they like.

But the take home message is that, if you follow any of the recipes word for word you’ll get a tasty toast-topper to enjoy. What you shouldn’t do is start out following recipe A, change over midway to recipe B and finish up with a dash of recipe C.

The day after Mr Pancreatic Cancer’s sister’s tirade, I got a letter from one of the local urologists. He’s known me for long enough to know that I don’t usually miss glaring physical signs, and he must have loved dictating, ‘By the way, Tony, your patient has testicular atrophy so obvious and profound that I’m amazed you failed to mention in your referral letter.’

I wasn’t amazed at all, because I had no idea that the patient had goolies the size of sultanas, if for no other reason that I’d never looked.

Mr Microgonads had originally consulted Dr A.N. Other, who, to be fair, had ordered all the right diagnostic tests and a near-zero testosterone level had fallen out of the blood work.

However, Dr Other’s modus operandi is to investigate first and ask questions later. Unlike yours truly, who wouldn’t dream of sticking needles into an impotent bloke before checking out his undercarriage. As there was no entry in the notes about an examination revealing a virtually empty scrotum, I just took it on trust that Dr Other had copped a quick feel and that all was well in the Y-front department.

I don’t really mind if a urologist wets himself giggling at a GP’s apparent schoolboy error, and perhaps I ought to accept that continuity of care is being left to wither on the vine, but we really should be doing our best to direct patients back to the doctor that ordered an investigation if the result is worth discussing.

Otherwise we inevitably run the risk of, ahem, dropping the occasional bollock.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.