I promised last week that I would blog about the Worst Thing I Have Ever Done. I felt terrible about it for ages, but looking back now after many years it doesn't appear quite as awful as it seemed at the time.
In those days I was a GP trainer, and my Registrar and I were doing an evening surgery in adjacent rooms on a Friday night. We were nearly at the end of the surgery and both of us were in a rush to finish and get away. She called me through to see a teenage boy who had been brought by his mother, and asked “is this rash meningitic?” The story was that the boy had been unwell for a day with sore throat, fever and rash, he had felt a bit achey and had a slight headache. I looked at the boy, his throat and the rash, and advised that it didn't look like the rash of meningitis. Because my Registrar was experienced and knew about safety-netting I didn't say a lot to the patient or his mother, and left it to my Registrar to finish the consultation properly and write it up.
My partner Elizabeth was on call next morning, for we provided an on call service for our patients on Saturday mornings in those days. She received a non-urgent request to visit the boy and got to his house towards lunchtime. His rash now looked meningitic and she admitted him to hospital. (He went on to make a full recovery with no damage done.) Elizabeth didn't want to spoil my weekend, so she didn't ring me up to tell me what had happened until Sunday evening. By that time my recollection of what I had seen and said was a bit foggy, and of course I had not made any notes. I immediately went to the surgery to see what my Registrar had written. “Rash seen by Dr Brown,” it said, “not meningitis”.
The patient's mother made a complaint to the practice. She refused to see me but had a meeting with two of my partners and I sent a letter of explanation and apology. She did not take the matter any further. I think this was in part because I had seen her on several occasions in the past and been fairly helpful. This was an example of “money in the bank” which I had paid in during those consultations but now had to withdraw. However she has not consulted me again from that day to this.
The art of medicine is often a matter of presentation. If they had come to see me rather than my Registrar I would have said something like “he doesn't look particularly ill and his rash is not typical of meningitis so I don't think he needs to go to hospital at present, but keep an eye on him and if he gets worse or the rash changes then ring again straight away”. Then I would have been remembered as the doctor who warned that it might be early meningitis and was proved right. But since I only gave an opinion to my Registrar, I was the doctor who said it wasn't meningitis and was proved wrong.
My Registrar later told me that she had indeed said all the right things I mentioned above, so my faith in her was justified. But the patient's mother still remembered that Dr Brown had said it wasn't meningitis. The incident shook me badly and I almost gave up training as a result, although I eventually continued for several more years.
I can see now that it is my depressive view of the world that makes my job a constant worry. Like Chicken Licken I fear that the sky will fall on my head at any minute, and on this occasion it did so. And when the sky falls it will be All My Fault. So this week I am trying hard to be more cheerful and optimistic, and to trust not only my patients but myself. (I have heard it said from the pulpit that God trusts us but we regularly fail to trust either him or ourselves, and I think that is true.) I am trying to see my patients as people who mostly come to see me willingly and hold a good opinion of me, and also to see myself as someone who is worth consulting.
Recently I saw a woman in her eighties who has previously seemed something of a bother, always worried and fussing. Last time I prescribed her a low dose of flupentixol, an old-fashioned GP remedy which sometimes cheers up the elderly. Now she looked a bit brighter and less worried. She told me that her worry about her poorly husband gets her low, she is “always waiting for the bomb to drop”. But she went on: “I couldn't survive without him, I love him so much” and said she was happy to carry on until the good Lord takes her. Balint would say that I prescribed not only the flupentixol but myself. And I also think that she helped to heal me a little.