PI Brief Update

How Medical Accidents Happen - Dr Mark Burgin

28/10/20. Dr. Mark Burgin BM BCh (oxon) MRCGP describes how best care can be a fail-dangerous system that make medical accidents inevitable.

There many aspects of the healthcare system that are designed to work well by taking risks such as the 10-minute GP consultation.

At its best having limited time means that the doctor and patient are focused on achieving psychosocial progress (an improvement in the patient’s life).

At its worst it prevents the patient from properly explaining what it wrong and discussing the doctor’s diagnosis due to pressure of time.

Depending upon GPs who are burned out to work in a system designed for the most brilliant (GPs) means that it is unavoidable that mistakes will happen.

Progress or fob off?

There is a tendency when under pressure to cut corners and avoiding dealing with difficult issues (that may upset the patient) is difficult to resist.

The difference in effort between saying ‘see you if things do not get better’ and explaining what the patient might need to do to get better is significant.

Over time the patient’s problems will increase if old problems remain unsorted as new problems occur which makes them more complex and difficult to help.

Eventually any opportunity to prevent the serious harm is lost and even with the best secondary care interventions cannot reverse the process.

The three-strike rule

Many doctors believe that if a problem is not resolved within three consultations the patient should be referred for specialist assessment.

It has a common-sense basis because in the days a patient was followed up by their own GP generally by the third presentation it would be obvious what needs to happen.

The rule depends upon the patient being able to get an appointment, the GP dealing with difficult issues and delay not being material for the illness.

Inappropriate use of the rule is to delay referral, making a referral before a full assessment has taken place and passing the problem to another GP.

Clues to Danger

Symptoms which can be associated with significant illness are called red flags because the GP must make them safe by further assessment.

Some of these symptoms are commonplace and others are difficult to make safe, so GPs rely upon patterns to identify the most likely cause.

When an assessment is too brief or if the GP does not include inconsistent findings attempts at pattern recognition can be dangerously inaccurate.

Coroner’s case for undiagnosed sepsis frequently identify multiple missed clues and a doctor who does too little too late to save a desperately ill patient.

Conclusions

The 10-minute consultation is a model which provided patients with contact with a highly trained and motivated professional according to need.

It has now deteriorated into brief anonymous contacts with someone who freely admits that they do not have time to read the previous records or deal with more than one problem.

The 10-minute consultation in its present form is dangerous and the GMC and RCGP should devise an alternative until a solution to doctor burnout is found.

I have recommended that patients prepare for consultations with a personal health summary (see my website) so that the doctor cannot say they were not told.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

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