Kevin Barraclough & Jenny du Toit 
Avoiding Errors in General Practice 

Some of the most important and best lessons in a
doctor’s career are learnt from mistakes. However, an
awareness of the common causes of medical errors and developing
positive behaviours can reduce the risk of mistakes and
litigation.

Written for Foundation Year doctors, trainees and general
practitioners, and unlike any other clinical management title
available, Avoiding Errors in General Practice identifies
and explains the most common errors likely to occur in an
outpatient setting – so that you won’t make them.



The first section in this brand new guide discusses the causes of
errors in general practice. The second and largest section consists
of case scenarios and includes expert and legal comment as well as
clinical teaching points and strategies to help you engage in safer
practice throughout your career. The final section discusses how to
deal with complaints and the subsequent potential medico-legal
consequences, helping to reduce your anxiety when dealing with the
consequences of an error.

Invaluable during the Foundation Years, Specialty Training and for
Consultants, Avoiding Errors in General Practice is the
perfect guide to help tackle the professional and emotional
challenges of life as a GP.

Table of Content

Contributors, viii

Preface ix

Abbreviations x

Introduction xii

Part 1

Section 1: The legal structure of negligence 1

A few words about error 1

Medical negligence 1

Learning from system failures – the vincristine example6

Reference 10

Section 2: Causes of diagnostic errors in general practiceand how they can be avoided 11

How do general practitioners reach diagnoses? 11

Where do errors occur in diagnosis? 15

How can we minimize the risks of these errors? 17

References and further reading 18

Section 3: Bayesian reasoning and avoiding diagnostic errors20

References and further reading 25

Section 4: A potpourri of advice on avoiding errors 26

History and examination 26

The telephone consultation 27

Communication problems 28

When lack of knowledge plays a part 28

The unexpectedly abnormal result 28

The standard of notes 29

Drug errors or prescribing errors 30

Consent 30

Confidentiality 32

Conditions that are ‘frequent flyers’ in negligence cases 33

Safety netting 34

References and further reading 36

Part 2 Clinical cases

Introduction 37

Case 1 A man with iron deficiency 38

Case 2 When is a headache abrupt? 41

Case 3 A woman with chest pain 44

Case 4 A dizzy man 48

Case 5 Rectal bleeding in a pregnant woman 51

Case 6 A pulled calf muscle 54

Case 7 A woman with hemiplegic migraine 57

Case 8 Irritable bowel syndrome after sickness in Goa 60

Case 9 A young man with back pain 64

Case 10 Irregular intermenstrual bleeding in a woman on the pill67

Case 11 A boy with a limp 70

Case 12 A runner with a cough 72

Case 13 A woman with classical migraine 74

Case 14 A young woman with diarrhoea and vomiting 77

Case 15 Ill-fitting dentures in an elderly man 79

Case 16 Back pain in a middle-aged woman 82

Case 17 Cellulitis in a man’s foot 85

Case 18 A flare-up of ulcerative colitis 88

Case 19 A woman with a skin lump on her leg 91

Case 20 A woman with microscopic haematuria 93

Case 21 A limping young girl 96

Case 22 A builder tripping over his feet 98

Case 23 An anxious young woman with hyperventilation 101

Case 24 A slightly raised AST in an Asian woman 103

Case 25 Cough and fever in a 42-year-old accountant 105

Case 26 Lost prescription: Benzodiazepine addiction 108

Case 27 A febrile baby 110

Case 28 A limping elderly woman after a fall 113

Case 29 Indigestion in a stressed executive 116

Case 30 A hoped-for pregnancy 119

Case 31 A breast lump that disappears 122

Case 32 Fever and cough after an ankle fusion 125

Case 33 Urinary problem in a welder 128

Case 34 A hypertensive 38-year-old woman 130

Case 35 A swollen lip in a 56-year-old man 133

Case 36 A woman with fatigue and weight gain 135

Case 37 A woman told off for ignoring her friends 137

Case 38 A man with a headache: Swine flu or meningitis? 140

Case 39 A woman suffering dizziness 142

Case 40 A middle-aged man with an ankle injury 144

Part 3 Investigating and dealing with errors

1 Introduction 147

2 How errors and their recurrence are prevented in primary care147

3 The role of the primary care trusts 150

4 Other investigations 152

5 Legal advice – where to get it and how to pay 155

6 External inquiries 157

7 The role of the doctor 172

8 Emotional repercussions 175

9 Conclusion 175

Reference 176

Index 177

About the author

Kevin Barraclough is General Practitioner, Painswick
Surgery, Painswick, Gloucestershire

Jenny du Toit is General Practitioner, Painswick
Surgery, Painswick, Gloucestershire

Jeremy Budd is General Practitioner, East Quay Medical
Centre, Bridgwater, Somerset

Joseph E. Raine is Consultant Paediatrician, Whittington
Hospital, London

Kate Williams is Partner, Radcliffes Le Brasseur
Solicitors, Leeds

Jonathan Bonser is Consultant in the Healthcare
Department of Fishburns LLP, Solicitors, London, and former Head of
the Claims and Legal Services, Department of the Leeds office of
the Medical Protection Society