Antonio Munno, A complaint that changed my practice, BMJ 332 p 1092
A complaint that changed my practice
The family asked to meet me. Their daughter had recovered from meningococcal septicaemia, and they wanted to know why I hadn't diagnosed it when they saw me that morning six weeks ago at the GP surgery. A few hours after I had treated her for an upper respiratory tract infection, her parents noticed a rash on her legs and took her straight to the accident and emergency department, where the seriousness of her condition was recognised.
The letter of complaint arrived a few weeks after she was discharged: How had I missed the diagnosis? And how was it that the emergency doctor who had seen their daughter at home a few hours before me had also dismissed her illness?
My stomach wrenched with anger and frustration. Can't they see? That's the whole point: two doctors a few hours apart both made the same clinical judgment that this was a viral illness. There was nothing that morning to indicate meningitis or septicaemia. To the family, the fact that two doctors had failed them compounded their criticism of the quality of care they received: to me, that double failure showed the difficult reality of naming an illness that often declares itself only with time.
I felt that their criticisms were unfair. Of the thousands of feverish children I would see in my career as a GP, only a handful would have something as devastating as meningococcal septicaemia. If I was unlucky enough to see the child at the wrong point on their journey of symptoms what else could I do?
As the date for our meeting drew closer, that black churning bitterness was still there, and I realised I had to do something.
I was interested in the work of Gillie Bolton and her ideas on the use of writing in personal and professional development.1 I decided to try one of her suggestions and write the story of the family's complaint from the point of view of the parents. The first line came easily: "She nearly died you know. Our daughter nearly died." At that point my perspective on the complaint changed. I felt the parents' fear, and I understood their terror. They had taken their ill child to a doctor and had trusted him to keep her safe. They needed a doctor to walk with them, support them, and to give meaning to their fears. The child got worse and nearly died. They lost the doctor; they could have lost their daughter.
The complaint wasn't about diagnostic skills or statistical probabilities but about a family trying to make sense of the horror of nearly being ripped apart forever. By thinking about the complaint from the family's point of view, I understood that my role in the meeting wasn't to defend but to listen.
Antonio Munno general practitioner, King Street Surgery, Kempston, Bedford (a.munno(at)ntlworld.com)