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A friend in need

01 May 2012

Mr A was a 55-year-old newsagent who had smoked 20 cigarettes a day for 30 years. He had been good friends with his GP, Dr B, for years – since they were children playing in the same football team.

Mr A had suffered with asthma since childhood. He visited Dr B regularly with exacerbations causing wheeziness and coughing, especially during the winter months. The visits were always kept very informal since they were friends, and Dr B’s medical notes were very brief, with minimal entries regarding Mr A’s presenting complaints or clinical examinations. Entries often comprised only the date and the prescription of inhalers.

Mr A had started suffering with back pain, which had not responded adequately to analgesia. It became severe enough to require hospital admission. A hospital CT scan revealed extensive mediastinal lymphadenopathy and parenchymal lung deposits. Mr A underwent bronchoscopy with biopsy, which confirmed the diagnosis of non-small cell carcinoma of the bronchus. Further scanning showed his disease to be metastatic involving his thoracic and lumbar spine, with a very poor prognosis. Unfortunately, Mr A deteriorated very rapidly, becoming very dyspnoeic and cachexic. He died just a few weeks after the diagnosis.

Mr A’s widow was devastated and made a claim against Dr B. She thought that her husband should have been investigated much earlier for severe breathing difficulties and weight loss. Dr B claimed from memory that Mr A had remained in good health with no breathing difficulties or weight loss till the weeks prior to his death. Dr B’s notes were so minimal it would have been impossible to confirm this.

Experts looking into the case reviewed Dr B’s minimal notes but also, fortunately, had the benefit of the hospital notes. The hospital notes confirmed that Mr A’s symptoms of weight loss and severe dyspnoea started after his hospital admission. There was heavy criticism of Dr B for his poor documentation. However, it was also agreed that since Mr A’s tumour was rapidly growing and aggressive, earlier diagnosis would not have improved his prognosis. The case was settled for a low amount.

Learning points

  • Clear and comprehensive notes are your defence when things go wrong. In this particular case the claims made by the deceased’s wife that the patient had been ill for a long time, could only be confirmed because of someone else’s medical records.
  • Wherever possible, you should avoid providing medical care to anyone with whom you have a close personal relationship. When treating those close to you, it could be easy to make assumptions, eg, regarding the way a patient is feeling if a doctor knows them already and does not ask the relevant questions, or it could be possible to over-identify with patients and lose objectivity.

Further information

  • Rourke L, Rourke J, Close friends as patients in rural practice, Can Fam Physician (June 1998)
  • GMC, Good Medical Practice (2011)
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