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
