Safety netting

A patient with with chronic obstructive pulmonary disease (COPD) who had smoked for many years saw a new GP about a persistent cough. The GP made a brief note of the consultation: ‘cough, no signs, likely exacerbation of COPD, for antibiotics and steroids, see as needed.’

Six months later, the patient returned after losing a significant amount of weight and the GP sent her for urgent tests, which led to a diagnosis of lung cancer.

The patient’s family complained to the GMC, whose expert report criticised the medical records and the GP’s failure to have provided any safety netting advice in a patient with risk factors for lung cancer.

The GP recognised that her record-keeping was inadequate at the first appointment and accepted she should have documented the examination and a thorough history. She also agreed that she should have specifically advised the patient to return for a re-assessment if the symptoms were not settling.

Noting that she had shown insight, the GMC case examiners agreed undertakings with the GP, including a commitment to complete further training and work under supervision pending a further review of her practice. These undertakings would stay on her record for 10 years.

MDU advice

• Many patients present to the GP with ambiguous symptoms that may or may not turn out to be something serious. Safety netting helps ensure they receive appropriate advice and that systems are in place to provide safe monitoring and follow-up.
• Be specific about when and how patients should seek further attention, a likely timescale to expect improvement, the ‘red flag’ symptoms to watch for, and how to access medical advice, especially in an emergency.
• As with any diagnosis, make a detailed record of the examination, positive and negative findings, and the advice you give. This will help colleagues who may see the patient after you, and will be important if your care is called into question.