Naming and shaming GPs

The word 'shame' is horrible. As soon as the threat of shame is made, then people close ranks and devise every any strategy they can to avoid being humiliated. Where has the idea of teamwork, cooperation and learning from errors and then improving, gone?

I agree wholeheartedly MiceElf - what's needed is to foster an open culture in which mistakes can be honestly discussed and lessons learned. Naming and Shaming is an unpleasant idea and will drive even more medical students away from wanting to work in general practice.

How have we got to a place where we might think of 'shaming' GPs? If any professional, regularly assessed and appraised, is found to be in need of further training they should follow that advice, not be shamed. Gross incompetence should be picked up and dealt with internally, gross misconduct dealt with by existing procedures, and missed diagnoses investigated to find out what could have been done better before deciding whether the GP was responsible for the error. Having a red flag on NHS records to identify GPs who delayed referring or missed diagnoses is a sorry way to deal with something that could be a combination of several reasons, one of which could be the systematic dismantling of the NHS by this government. Let's start any 'shaming' by publishing a league table of MPs who don't bother to attend debates about NHS concerns and don't understand what GPs need to keep on top of patients' health issues.

GPs like other health professionals are required to engage in clinical audit a research process which highlights and good and bad practice and enables learning. If this latest idea goes through it will push up the referral rates, lengthen waiting lists and cost more money.

My mum died after her lung cancer was misdiagnosed. She'd had a chest XRay and rang up the surgery to ask about results. The receptionist told her that she had emphysema. That's pretty outrageous for a start, a non medically qualified person should not be telling someone something like that.
A couple of months later, she was rushed into hospital and diagnosed with lung cancer. The hospital staff were lovely, especially the MacMillan nurses. Her GP acted like he couldn't care less whether she lived or died.
We all asked ourselves the question, why did the GP not see the cancer on the XRay? It might have saved her, and even if it didn't we'd all have had more time to spend with her if we'd known.
The news today reminded me of what happened to my mum. No, I don't think "shaming" GPs is a good idea. But I don't think leaving incompetent or negligent GPs in place is a good thing either.

I'm not very knowledgeable about this subject, DonnaBe, but shouldn't the radiology department have been responsible for checking the results of the x-ray? I thought they sent their findings to to the GP.

I'm very sorry about your mum, and I agree that the receptionist shouldn't have been giving out that sort of information to a patient, especially over the phone.

As the wife of a doctor I have every reason to know that they too are human and fallible. My OH's mental health was destroyed by the anxiety that he might make a major mistake like this.

Whilst we do need to weed out inadequate and dangerous doctors, we also need to recognise that there is more to gain by learning from errors than a witch hunt. Errors will happen - they cannot be totally eliminated. We have to accept that.

Another factor that we need to acknowledge is that doctors are no longer as well-trained as they were. The changes in training in medical school mean that junior doctors arrive on the ward never having learned to take blood (a very basic skill); and the reduction in junior doctors' hours, whilst giving them a life, also means that they do not have time to learn all the things that they need to learn. A difficult balance to strike.

I am very worried about the quality of our medical workforce, as I hear over and over again about misdiagnoses. Sometimes when friends are telling me their experiences, even I, as a non-medic (but hospital social worker for many years and wife of a GP - so something rubs off) know that the diagnoses are wrong - what to do, what to say? - my OH and I have been in this position more times than I can count.

Hear hear!

Ana…. you may be right. Perhaps we've been shooting the messenger. It was several years ago and the whole family were angry with the GP.

Of course we want diagnoses to be as accurate and as early as possible but if diagnosis was as easy as it is to make macho political statements, doctors wouldn't need years of training. I think this is a case of deliberate misdirection. Attacking doctors will distract the public from the real problems in the NHS.

It took somewhere between 18 months and 2 years to diagnose DH's cancer, but it wasn't for lack of effort on the GP's part. He was sent for any number of tests during that time and we had a long list of things that weren't wrong with him. He just happened to have a rare and hard to diagnose version of his cancer which was left as the only alternative when a whole range of others had been ruled out. Certainly since the diagnosis there has been no lack of care from the GP's. Only this week one of them rang because she was worried about a blood test result and I had to reassure her that I had already spoken to the consultant and it was all under control.

As I understand it, doctors who have been found guilty of negligence by the GMC are already named and shamed on the GMC website for all to see.
Do Jeremy Hunt and the Daily Mail want blood, too? Doctors have the highest rate of suicide, alcohol and drug abuse of any professional group. I am sure that no doctor goes to work in the morning and decides that today he or she will deliberately miss a diagnosis.

How will it be decided how these red flags are awarded?
Any process would have to be fair and transparent and the costs press lay borne by the NHS, diverting money from patient care.

The problem that appears to be exercising Jeremy Hunt is our higher death rate from cancer, compared to other European countries, because of late diagnosis.

GPs are only part of the process and only part of the problem. Lack of facilities, and waits to see consultants within the hospital system once the diagnosis has been made are also factors.
But GPs are convenient scapegoats, aren't they.

Yes absolutely jane - JH is muddling up all sorts of issues here . Clinical governance is one of the issues here and it IS very variable amongst GP practices. Things shouldn't be able to get to the red flag stage as any GP/ practice demonstrating diagnostic incompetence ( and would that just be of cancers if that were the case?) should have internal systems that pick that up. In addition, I am sure there has been research that shows for some reason we, as a population, present late with cancer symptoms. It would be worth investigating the factors that influence that. For example, do people in more deprived areas present later? Could a factor here be just greater morbidity in general which sort of ' masks' cancer symptoms?

Grannytwice I agree that clinical audit within practices should =pick up mis- and under-diagnosis.

I can't find any reference to specific research about why British people present late, but the Cancer Research website points to the fact that over a third of diagnoses are made in people over the age of 75.
www.cancerresearchuk.org/cancer-info/cancerstats/incidence/age/

That generation tends to have a stoic 'mustn't-bother-the-doctor-unnecessarily' mentality, and of course they are more likely than younger patients to have other degenerative conditions at the same time, which may mask the cancer symptoms.

Naming and shaming is another B stupid Government idea.
They are just trying to be seen to reacting to the news item rather than wanting to spend any money to improve services .
As the ? BMA said just improve resources.

On the news tonight it said that patients later found to have cancer, visit their GP on average 3 times before being referred to a cancer specialist. By which time the cancer has often metastasised.

It's a pity there isn't a blood test that can detect markers for cancer.
I did read though that some breast cancers will soon be able to be detected by a blood test even up to three years before it actually shows.
This is a possible way forward.

There's a blood test for ovarian cancer, according to my GP and I believe there is also one for prostate cancer.

Early diagnosis through screening is not always beneficial though, Aka.
Some doctors are concerned about over-diagnosis and over-treatment , ie if the cancers that are picked up are slow-growing, they may never cause illness and treating them may cause harm.
There is no easy answer, and the government pressurising GPs by namimg and shaming is not going to lead to a rational approach.

You beat me to it jane. One example is prostate cancer in older patients- where operating can often cause many more problems than non-treatment.

Thinking too about what happens when doctors become over-worried about being sued- and countries like the USA where the majority of births are now done by Caesarian, for that reason rather than clinical need.

We have a huge shortage of doctors, how is this encourage more young people to join the profession?

My darling husband died due to non diagnosis by GP and DH not fraying accurate information about an examination done by the GP to me!

For over a year my husband had cancer markers suggesting that he had pancreatic cancer, but it did not progress. Then in August 2011, he had a fit. He was sent to hospital and they decided it was a urine infection.
In September he was sent to hospital again after having a series of small fits, and brain cancer was diagnosed.
He was operated on in October, had radiotherapy in November/December, and died in January, 2012.
Our GP asked if they'd missed anything. If anyone did, it was the hospital doctors. But the specialist he was under who spotted the original cancer markers said that nothing they did would have changed things, as nobody spotted the brain cancer.
What would be the point of naming the GP? I'd rather name the GP who said my husband was greedy for getting the brain cancer. In fact, we did.
But that's nothing to do with whether the cancer was spotted late or not.
It's no answer to make people suspicious of GPs. I am more suspicious of a private company that wants to make a profit out of people having cancer.

Some GPs are very good, and some are not- I wish they would all listen to their patients and not dismiss their concerns, and realise that not everything conforms to their normal expectations :
My friend Roy aged 48 lost weight rapidly and was tired all the time - GP dismissed it as stress and overwork - he died of bowel cancer on his 50th birthday
My friend Gemma died at 24 , after visiting her GP aged 21 with a lump in her breast, dismissed with 'girls your age don't get breast cancer' - eventually diagnosed when her bones started to crumble as it had spread
Daughters friend - dead at 21- cervical cancer -symptoms ignored, smear refused as she wasn't 25....
And tragically my dear DGD's friend, aged just three, dying even as I write - Mummy ignored for 6 months and labelled an over anxious mother....

If this new system makes GPs actually think outside the box, and think the unthinkable lives would be saved

Those examples that you give susie are so common - I could quote a whole list too. It is very worrying, but I am not sure what the answer is.

I can understand all the un happines, if you have been wrongly diagnosed or not diagnosed, I appreciate that there is not enough sorry's in the world to make up for that, but just wanted to add that my two Doctor friends are very hard working caring Doctors that sometimes can not sleep due to concerns for patients they are seeing, Yes they do get it wrong, they are only human at the end of the day and that is why my attitude has always been do not totaly rely on anyone other than yourself for your health--what I mean by that is, in a way you have to be your own Doctor, if you feel something is wrong and you are not happy with a Doctor, then go to another.

We never talk about all the hours Doctors put in, we never talk about the near miracles they perform and how clever some Doctors are, we never talk about the millions of lives Doctors save every year..but are very quick to judge them and criticise them.