Fillers A memorable patient

When a medical qualification is not good enough

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:827
  1. Guy Houghton, flexible career scheme GP and associate dean GP, West Midlands Deanery (guy{at}
  1. Birmingham

    I was born into a medical family, and I clearly recollect saying, at the age of 4, that I was going to be a doctor like my father: this predated my older sister's and brother's decisions to read medicine. My father had joined his father in general practice, and two of his brothers also became GPs. My mother, whose parents were both medically qualified, was in the same year at medical school as my father and was also a partner in the practice.

    Patients certainly appreciated the continuity of family care, though I was to learn that their approbation concealed underlying expectations.

    I received a call during a Tuesday evening surgery some 25 years ago, requesting advice about a patient. This woman was in her late 60s and had had a visit the day before from my GP registrar for diarrhoea and a presumptive diagnosis of gastroenteritis. He had examined her and suggested fluids and symptomatic treatment. She was staying with a friend outside the practice area, but I agreed that, if she could be brought home, I would visit her after surgery. This I duly did and could not find anything to suggest any other pathology; I duly noted her dry tongue and thirst, which I attributed to mild dehydration.

    Her friend took her back so as to look after her and called in a deputy GP the next day, and his own doctor the day after, who admitted her to hospital, where, she was to tell me later, it took another day to make the diagnosis. I went to see her after she was discharged and apologised for the delay in her receiving appropriate treatment. I said my only defence was that new onset, non-ketotic diabetic hyperglycaemia was uncommon and at least four other doctors had also failed to make the diagnosis.

    She replied that she could forgive all the others, but not me—I should have done better because I was a Houghton.

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