Angry Patient: GP Missed Mother's Diagnosis

Casebank Counselling
1

Where are you:
You are an FY2 in the Respiratory unit.

Who the patient is:
Cynthia Jones is an 72 year old woman who was admitted 2 days ago with a cough.

Other information you have about the patient:
Now she has been diagnosed with lung cancer.
She smokes 40 cigarettes a day and she has history of COPD.

What you must do:
Talk to the son and address the concerns.

Structure: Angry Patient

Scenario background:

  • Son himself took his mother to GP multiple times in last few days and the GP had suggested it was a lung infection, therefore had advised antibiotics but yesterday the son has been informed that it’s a lung cancer, which has made him upset and angry.

Invite

  • I understand that your mother has been admitted with us.
  • I also understand that you wanted to speak to one of the doctors.
  • How can I help you? Is there anything in particular you want to discuss with us?
  • Son will share everything, show you angry and frustration.

Listen

AVE

  • I’m sorry to hear that your mother has been diagnosed with lung cancer.
  • This must have been difficult for you, your mom and family. I’m sorry you had to go through this.
  • Don’t say: Anyone in your situation will feel the same. GP had missed your diagnosis.
  • I understand you’re upset about the delay in diagnosis.

Reassure & Signpost

History

  • Can I ask you some questions to have better understanding about what has been happening with your mother?

Idea

  • Can I ask you, what made you think that her GP missed her diagnosis?
  • Is there anything in particular you have been noticing, that GP could have picked it up earlier?
  • You’ve mentioned that your mother has been going to GPs, so how many times has she visited?
  • For what reasons?
  • What sort of symptoms she has been experiencing?
  • Cancer questions
    – Was she having any cough?
    – Was she coughing up any blood?
    – Any shortness of breath?
    – Any weight loss?
    – Any tiredness?
    – Any pain in the body?
    – Anything else happened?
  • What sort of investigation were done for her?
  • Did they do any X-ray (Chest X-ray), examine her phlegm, any blood tests?
  • What were they telling you was wrong with your mother?
  • What sort of treatment did they offer?
  • Did she improve with the treatment? Was that helpful?
  • Apart from this, does she have any longterm medical problem? (Son will mention about COPD)
  • Ask about risk factor,
    – Did she smoke?
    – Anyone in family was diagnosed with cancer?

Social history

  • Who does she live with?
  • Are you the LPA (Lasting power of attorney)?

Concern

  • Is there anything in particular you are concerned about?

Expectation

  • I understand that you were unhappy and wanted to speak with one of the doctor but is there any specific you want me to address?

Explanation

Your explanation is that you don’t know anything. You never try to defend or blame the GP. Explain what you can do for him

  • You can explain like “Unfortunately, at the moment I don’t have any information, in terms of how your mother was treated by the GP.” Or say “… your GP’s impression about your mother’s condition and what they’ve done for your mother, or what they were thinking.”

  • I clearly understand that you some questions, why there was so much delay. Therefore, I’m going raise this concern to my senior, that your GP had missed the diagnosis.

  • Explain the steps taken by the seniors:

    1. They’ll do the preliminary investigation in which they might speak to you and your mother, to know what went wrong.
    2. They’ll review everything that has been done for your mother from the onset of the symptom, and check if there was anything significantly missed. Was there anything alarming?
    3. If something significant is found then they’ll launch the proper investigation on this matter. This investigation could take place at department or hospital level.
    4. Once they finish investigating at the department or hospital level, and if they find something significantly missed then they’ll refer to Medical Council.
    5. Then medical council will run their own investigation on this matter. They might collect statement from you, your mother, GP and whoever was involved in this matter.
    6. They’ll analyse, conclude the investigation and take necessary action.

P: What is Medical Council?
D: They’re our regulating body.
P: Are you going to action against the GP? Are you going to punish the GP?
D: The action against the GP is taken by the medical council. The decision can be temporarily suspending someone or permanent eraser from the hospital.
P: Can I take a legal action? Or Can I complain?
D: This is entirely up to you, if you feel like you wanted to take a legal action then definitely can. In my position, I can’t ask you or stop you from taking a legal action. What I can offer you is PALS, patient advisory license services. It’s the independent body who speak for the patient. You can speak to them, and they’ll advise you what to do next. I can guide you to them.

  • Firstly, I wanted you to understand your position, secondly, if someone wants to make a complain like that then what can they do.
  • Don’t say: I’m going to speak to your GP. Never say it’s an error or mistake or medical error.
7 Likes
2

Could you explain why we should avoid saying ‘anyone in your situation’? This phrase is often used when dealing with angry patients or medical errors, and I’d like to understand the reasoning behind this advice

1 Like
3

can we able to say PALS in case of GP misdiagnosis case,does that apply in GP setting thank you

1 Like
4

You can say, I will arrange practice manager or commissioner of the services, they can help you to make a complaint

5

how can we say we can arrange practice manager? can’t we say you can follow the GP complaints procedure for complaints by contacting the GP practice manager…thank you

6

Lovaan says you can say it when doing EVA protocol - for validation.