I remember one of my favourite patients from my old practice. An elderly gentleman with a cheeky London accent who had nursed his beloved wife through dementia and kidney failure, he used to see me about once a month.
One time he mentioned struggling to breathe on exertion, examination and investigation revealed nothing more sinister than an irregular heartbeat that he'd had for some years.
When he brought it up a second time we chatted a bit about how we could try medication, but his limited kidney function may deteriorate and decided to leave things be.
Then I had a week off. It wasn't a holiday, just one of those weeks where you catch up on neglected housework and DIY.
I returned to work not much refreshed but when he entered my room with his familiar shuffle and brought up the shortness of breath, something made me start again from scratch and re-examine his chest.
He had an unmissable pleural effusion (fluid in the lungs) and I sent him in to hospital that day where he had it drained, charmed all the nurses and was soon home again and feeling much better.
It's incredibly easy as a GP, seeing the same patients over again, to dismiss symptoms you have already investigated.
Having a break away can sometimes be enough to trigger you to look at things afresh.
GMC reports from 2009 showed single handed GPs were 6 times more likely to face a GMC complaint than GPs working in a partnership, while there are plenty of confounding factors the lack of opportunity for a second opinion or a break and a fresh approach are surely adding to the risk of missed diagnoses.
So don't try to be a hero and not take your annual leave allowance. You may be doing your patients a disservice as well as yourself.
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