Two stories this week will have prompted the same question. Specifically, why are we GPs so dumb?
One involved a young boy whose nine years of deafness was not, as his doctors had suggested, caused by wax. This became apparent when the tip of a long-forgotten cotton bud popped out of his ear, completely curing his problem. The other reported the case of a 40-year-old woman who had been told by her doc that her symptoms were the menopause. Only hours later, she, too, found something popping out of somewhere. But it was a 5lb 6oz baby, and it didn’t emerge from her ear canal.
So, a foreign body misdiagnosed as ear wax. And a new body misdiagnosed as the menopause. How is it that GPs can get it so wrong?
Believe me, it’s easy. Take those two examples. The offending cotton bud would have been fossilised in a nine-year sediment of wax, cruelly misleading the GP. Besides, the child couldn’t respond properly to the key question – “Could you have got a cotton bud stuck in your ear?” – on account of being, well, deaf.
As for the menopausal child-bearer, consider the symptoms of tiredness, bloating, absent periods, weight gain and emotional wobbliness. See? Pregnancy or the menopause? It’s the toss of a coin, really.
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Besides, you have to consider the sheer volume of cases dealt with by the average GP. I see about 40 patients every day, many presenting multiple problems and some smuggling in relatives beneath the receptionist’s radar to bypass the appointment system. That’s about 9,000 clinical dilemmas posed each year and on a distracting background of en passant gripes about the waiting room decor, moans about GPs no longer doing out-of-hours and toddlers puking on the carpet.
It’s like trying to win the Speed Su Doku championship while being poked with a cattle prod. Given that a diagnostic cockup is only ever a misled doctor or a misheard symptom, the surprise is not that there are so many “Dumb-ass GP” headlines but that there are so few.
Then, of course, there’s the fact that we GPs see illness at its earliest stages, when it’s most difficult to diagnose. So, “I’m worried about my child, she’s vomited twice in the last ten minutes,” poses a problem and not just because I’ve got to clean my carpet again. It’s more that the list of possible diagnoses encompasses just about every condition known to man.
Hence the “It’s probably a virus” mantra. Unfortunately, Mum inevitably forgets the “probably” bit and also the “contact me if she gets any worse” addendum, which is why, when the classical symptoms appear later and the whitecoated hospital heroes cure her daughter’s meningococcal septicaemia, I’m left looking like a negligent numbskull, as the local paper will describe me.
But you patients have to take some responsibility, too. Histories that boil down to “I’ve been feeling iffy for some time” do little to narrow down the list of pathological possibilities. And the opposite extreme – self-diagnosis – is equally misleading. Patients who claim that they’re depressed are inevitably just unhappy, those who fear they’re demented are inevitably depressed, and those who insist they have chronic fatigue syndrome are inevitably shown the door before I snap.
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The classic self-misdiagnosis, though, is the heart attack. If you think you’re having one, you probably aren’t. But if you protest that “It’s just a bout of indigestion”, I’m dialling 999 before you can pretend the antacids have worked. After all, most of my working day I’m fighting off demands and exaggeration, so the time you underplay your symptoms is when I start panicking. The other being when you phone to ask if it’s normal for the HRT I’ve been prescribing to cause odd kicking sensations in your abdomen.
Dr Copperfield is a GP in Essex. He also writes for DoctorPortal.co.uk Mark Henderson is away