Avoiding Errors in General Practice

Some of the most important and best lessons in adoctor's career are learnt from mistakes. However, anawareness of the common causes of medical errors and developingpositive behaviours can reduce the risk of mistakes andlitigation.Written for Foundation Year doctors, trainees and generalpractitioners, and unlike any other clinical management titleavailable, Avoiding Errors in General Practice identifiesand explains the most common errors likely to occur in anoutpatient setting - so that you won't make them.The first section in this brand new guide discusses the causes oferrors in general practice. The second and largest section consistsof case scenarios and includes expert and legal comment as well asclinical teaching points and strategies to help you engage in saferpractice throughout your career. The final section discusses how todeal with complaints and the subsequent potential medico-legalconsequences, helping to reduce your anxiety when dealing with theconsequences of an error.Invaluable during the Foundation Years, Specialty Training and forConsultants, Avoiding Errors in General Practice is theperfect guide to help tackle the professional and emotionalchallenges of life as a GP.

Contributors, viiiPreface ixAbbreviations xIntroduction xiiPart 1Section 1: The legal structure of negligence 1A few words about error 1Medical negligence 1Learning from system failures - the vincristine example6Reference 10Section 2: Causes of diagnostic errors in general practiceand how they can be avoided 11How do general practitioners reach diagnoses? 11Where do errors occur in diagnosis? 15How can we minimize the risks of these errors? 17References and further reading 18Section 3: Bayesian reasoning and avoiding diagnostic errors20References and further reading 25Section 4: A potpourri of advice on avoiding errors 26History and examination 26The telephone consultation 27Communication problems 28When lack of knowledge plays a part 28The unexpectedly abnormal result 28The standard of notes 29Drug errors or prescribing errors 30Consent 30Confidentiality 32Conditions that are 'frequent flyers' in negligence cases 33Safety netting 34References and further reading 36Part 2 Clinical casesIntroduction 37Case 1 A man with iron deficiency 38Case 2 When is a headache abrupt? 41Case 3 A woman with chest pain 44Case 4 A dizzy man 48Case 5 Rectal bleeding in a pregnant woman 51Case 6 A pulled calf muscle 54Case 7 A woman with hemiplegic migraine 57Case 8 Irritable bowel syndrome after sickness in Goa 60Case 9 A young man with back pain 64Case 10 Irregular intermenstrual bleeding in a woman on the pill67Case 11 A boy with a limp 70Case 12 A runner with a cough 72Case 13 A woman with classical migraine 74Case 14 A young woman with diarrhoea and vomiting 77Case 15 Ill-fitting dentures in an elderly man 79Case 16 Back pain in a middle-aged woman 82Case 17 Cellulitis in a man's foot 85Case 18 A flare-up of ulcerative colitis 88Case 19 A woman with a skin lump on her leg 91Case 20 A woman with microscopic haematuria 93Case 21 A limping young girl 96Case 22 A builder tripping over his feet 98Case 23 An anxious young woman with hyperventilation 101Case 24 A slightly raised AST in an Asian woman 103Case 25 Cough and fever in a 42-year-old accountant 105Case 26 Lost prescription: Benzodiazepine addiction 108Case 27 A febrile baby 110Case 28 A limping elderly woman after a fall 113Case 29 Indigestion in a stressed executive 116Case 30 A hoped-for pregnancy 119Case 31 A breast lump that disappears 122Case 32 Fever and cough after an ankle fusion 125Case 33 Urinary problem in a welder 128Case 34 A hypertensive 38-year-old woman 130Case 35 A swollen lip in a 56-year-old man 133Case 36 A woman with fatigue and weight gain 135Case 37 A woman told off for ignoring her friends 137Case 38 A man with a headache: Swine flu or meningitis? 140Case 39 A woman suffering dizziness 142Case 40 A middle-aged man with an ankle injury 144Part 3 Investigating and dealing with errors1 Introduction 1472 How errors and their recurrence are prevented in primary care1473 The role of the primary care trusts 1504 Other investigations 1525 Legal advice - where to get it and how to pay 1556 External inquiries 1577 The role of the doctor 1728 Emotional repercussions 1759 Conclusion 175Reference 176Index 177