Avoiding Errors in General Practice

Contributors, viii Preface, ix Abbreviations, x Introduction, xii Part 1 Section 1: The legal structure of negligence, 1 A few words about error, 1 Medical negligence, 1 Learning from system failures - the vincristine example, 6 Reference, 10 Section 2: Causes of diagnostic errors in general practice and how they can be avoided, 11 How do general practitioners reach diagnoses?, 11 Where do errors occur in diagnosis?, 15 How can we minimize the risks of these errors?, 17 References and further reading, 18 Section 3: Bayesian reasoning and avoiding diagnostic errors, 20 References and further reading, 25 Section 4: A potpourri of advice on avoiding errors, 26 History and examination, 26 The telephone consultation, 27 Communication problems, 28 When lack of knowledge plays a part, 28 The unexpectedly abnormal result, 28 The standard of notes, 29 Drug errors or prescribing errors, 30 Consent, 30 Confidentiality, 32 Conditions that are 'frequent flyers' in negligence cases, 33 Safety netting, 34 References and further reading, 36 Part 2 Clinical cases Introduction, 37 Case 1 A man with iron deficiency, 38 Case 2 When is a headache abrupt?, 41 Case 3 A woman with chest pain, 44 Case 4 A dizzy man, 48 Case 5 Rectal bleeding in a pregnant woman, 51 Case 6 A pulled calf muscle, 54 Case 7 A woman with hemiplegic migraine, 57 Case 8 Irritable bowel syndrome after sickness in Goa, 60 Case 9 A young man with back pain, 64 Case 10 Irregular intermenstrual bleeding in a woman on the pill, 67 Case 11 A boy with a limp, 70 Case 12 A runner with a cough, 72 Case 13 A woman with classical migraine, 74 Case 14 A young woman with diarrhoea and vomiting, 77 Case 15 Ill-fitting dentures in an elderly man, 79 Case 16 Back pain in a middle-aged woman, 82 Case 17 Cellulitis in a man's foot, 85 Case 18 A flare-up of ulcerative colitis, 88 Case 19 A woman with a skin lump on her leg, 91 Case 20 A woman with microscopic haematuria, 93 Case 21 A limping young girl, 96 Case 22 A builder tripping over his feet, 98 Case 23 An anxious young woman with hyperventilation, 101 Case 24 A slightly raised AST in an Asian woman, 103 Case 25 Cough and fever in a 42-year-old accountant, 105 Case 26 Lost prescription: Benzodiazepine addiction, 108 Case 27 A febrile baby, 110 Case 28 A limping elderly woman after a fall, 113 Case 29 Indigestion in a stressed executive, 116 Case 30 A hoped-for pregnancy, 119 Case 31 A breast lump that disappears, 122 Case 32 Fever and cough after an ankle fusion, 125 Case 33 Urinary problem in a welder, 128 Case 34 A hypertensive 38-year-old woman, 130 Case 35 A swollen lip in a 56-year-old man, 133 Case 36 A woman with fatigue and weight gain, 135 Case 37 A woman told off for ignoring her friends, 137 Case 38 A man with a headache: Swine flu or meningitis?, 140 Case 39 A woman suffering dizziness, 142 Case 40 A middle-aged man with an ankle injury, 144 Part 3 Investigating and dealing with errors 1 Introduction, 147 2 How errors and their recurrence are prevented in primary care, 147 3 The role of the primary care trusts, 150 4 Other investigations, 152 5 Legal advice - where to get it and how to pay, 155 6 External inquiries, 157 7 The role of the doctor, 172 8 Emotional repercussions, 175 9 Conclusion, 175 Reference, 176 Index, 177