Further Confessions of a GP

The coroner

It was 8:15 on a Wednesday morning and I had just arrived at work. I had barely taken off my coat when the receptionist put a call through to me.

‘Morning, Dr Daniels, it’s the coroner’s office here.’

A wave of anxiety washed over me. The coroner only calls when someone has died and usually when that death is unexpected.

‘Barry Dawkins. Know him? Date of birth 22 April 1963. He was found dead at home last night by his wife.’

The name rang a bell but I really couldn’t picture him. Having been born in the year 1963 made him only just 50. Why had he died? That’s much too young.

My slow NHS computer was taking a lifetime to boot up. I was repeating the name Barry Dawkins over and over in my mind. Why couldn’t I picture him? Who was he? Had I missed something? Of course, with more than 6,000 patients registered at our surgery, one or two tend to fall off their perch every month or so, but normally these are patients who are expected to die and the coroner doesn’t get involved.

The coroner’s office deals with deaths that are violent or unexplained. They often call for a post-mortem and sometimes order an inquest to clarify the details surrounding the death. A coroner’s inquest can be a scary place for doctors. They are not a criminal court and so can’t attribute criminal negligence, but they often still involve a doctor standing up under oath and trying to justify why they did or did not do something with regard to a patient’s care.

When I finally got Barry Dawkins’ notes up, I scrolled through in a slight panic wondering if I might have missed something. He’d been in a few times recently for a review of his blood pressure and diabetes, but that was about it. My biggest fear was that he had presented with symptoms that I had dismissed, which he had then gone on to die from. Could he have had a burst aorta that I’d dismissed as simple back pain, or a bleed on the brain that I’d thought was a migraine? I was mightily relieved to see that no such mistake had been made, but a pang of guilt washed over me as I realised that selfish self-preservation was all I’d been able to think about upon hearing of this man’s untimely death.

The coroner disrupted my thoughts.

‘So, Dr Daniels, what medication had you been prescribing him? Did you start him on any new medication just before he died?’

Bloody hell, I hadn’t even thought about that. Could some wayward prescribing on my part have contributed to his death? Suddenly, I sharply switched back into self-preservation mode. The medications I had prescribed to Mr Dawkins were all fairly common, but as the coroner was hinting, they could have all potentially killed him: the aspirin could have caused a bleed from his stomach; the diabetes medication could have dropped his blood sugar causing him to die of hypoglycaemia; the blood pressure tablets might have caused him to faint and bash his head; and the combination of his cholesterol tablets and excessive drinking might have given him liver failure.

I carefully explained all the medications to the coroner, and as I put the phone down I sat quietly stewing in a light sweat, again wondering about my potential influence over another man’s life. I took another good look through Mr Dawkins’ notes. Much as I was annoyed by the computer record’s constant flashing up of targets, one number did jump out at me from Mr Dawkins’ records. His risk score of dying in the next 10 years was 47 per cent. Clearly a stupid statistic to remain on the records of a man already dead, but basically the computer was working out the risk of him having a heart attack or stroke based on his weight, blood pressure, smoking history, diabetes, cholesterol and age. The statistic was basically stating that despite being young, his other risk factors made dying not that unlikely. I was still a bit worried that the medications I had prescribed might have killed him, but I was now also considering that perhaps his death had resulted in me not having treated his risk factors aggressively enough.

I took a good look through his notes and was reassured by the amount of time the doctors and nurses at this surgery had spent advising him to stop smoking and lose weight and take better control of his diabetes. We were constantly trying to get his blood pressure under control and, to be honest, I’m not really sure what more we could have done for him.

I still had a nervous wait for the result of the post-mortem. When it came, it was no surprise to learn that he had died from a massive heart attack, but I can’t pretend that my initial reaction wasn’t relief that I had played no untoward part in his demise. In some ways we should consider it a success that we now see the death of a man in his 50s as such a shocking event. It didn’t used to be, and it is because doctors and patients have got better at reducing the risk factors. I phoned up his poor widow to offer my condolences and support and she asked me if she could book into our stop-smoking clinic.