29 Jan Practicing in a climate of fear
I saw a patient this week. They were over 60, their gender doesn’t matter, but they came in with a simple history.
“I hadn’t been to the loo for 4 days, then I did, and I bled”
Straightforward really. Easy peasy. I went through the history, asking about all the red flags, checking for other symptoms. The examination was boringly normal so I sat down while the patient got dressed to talk through what we were going to do.
Then I thought about being sued and I stopped.
My diagnosis and management plan were sensible. Common things are common and I knew this didn’t need an urgent referral. In fact, it didn’t even fit the criteria for a 2 week wait. I knew what had caused the bleeding, there were no red flags. Why should I be thinking about being sued?
“I hate that I sat at my desk and doubted myself because of the climate we now practice in.“
Reflecting on your diagnosis and treatment is part of being a GP. Having a differential in your brain because yes, while common things are common, one of the things we do best is put together disparate pieces of a puzzle and sometimes – suddenly – the dots are connected. I know the areas I’m good at. I know the areas I’m not, and I am more than happy to ask a colleague for advice if they have more experience than me. I’m happy to admit to a patient I need to double check a guideline or the BNF because I’m not so arrogant as to assume I know everything.
But this feels different – this feels as though someone is out there, just waiting for me to make a mistake. Not to be clinically negligent and dangerous, but to be simply human. The phrase “practicing in a climate of fear” has been used, and it’s true. I’ve been lucky not to have a major complaint in my career so far that has gone the full distance to lawyers and courts, but I know it’s only a matter of time. Whenever I speak to colleagues who have, or I read the postings on social media, or the magazines from the defence organisations, the cases are always ones I can easily identify with. After all, that’s what our significant events are that we present at appraisal every year. When something almost went wrong but didn’t, or it did go wrong and what we can learn.
I met a colleague once who had one such complaint – it had gone all the way down the legal system, and his MDO had settled. Not – they were clear – because he had done anything wrong, but because the chances of them winning and the costs of a court case, meant it was cheaper to settle. Ever since then, he refers everything. He knows it isn’t cost effective. He knows it isn’t good medicine. He knows it’s not in his patients interests all the time. But how I feel today, sat in front of my computer, is a tiny fragment of how he must feel in every single appointment.
When the patient sits down, I’m still undecided. I opt for the strategy that has worked so far, and I talk to them. Together, we make a decision. It’s not foolproof, but I feel a lot happier practising as part of a team with my patients, than I do catastrophising every 10 minutes.
I’m sure I’ll come a cropper at some point, but I refuse to spend my career making decisions based on how scared I feel that day, rather than what is right.
Dr Zoe Norris is a portfolio GP in Hull. Having worked as a salaried GP and partner, she became a well known name by writing for the Huffington post and blogging about the challenges GPs were facing across the country.
Zoe took on the role of media lead for the online group GP Survival, while working in roles as a locum GP, GP appraiser, and lecturer for the NB Medical Hot Topics courses.
She is a sessional member of Humberside LMC, Yorkshire sessional representative, and was elected as Chair of the GPC UK sessional subcommittee in July last year.
She continues to support the online groups of GP Survival and Resilient GP, and is a columnist for Pulse.