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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2009 November 1; 59(568): 874.
PMCID: PMC2765845


Thanks for the plug, folks. It's gratifying to find that what just seemed common sense when I first wrote about safety-netting in 1987 has survived the scrutiny of proper researchers and is now thought ‘arguably the most important part of the diagnostic process.’

So why was I left feeling a tiny bit flat? It's certainly not for any lack of facts, logic, or passion in this cogently-argued piece.1 I suspect it's more to do with how general practice itself has changed in the interim. Twenty years ago, safety-netting seemed a necessary safeguard against a sloppy over-confidence that made some of us think that, in general practice, near enough was good enough, and only other people made mistakes that mattered. But now, it seems, we need safety-netting as a remedy for under-confidence; under-confidence that flows from reduced clinical exposure in the training years and the ‘fear of God’ effect of an inundation of guidelines and protocols disobeyed at one's peril. We have become so used to GPs ‘managing uncertainty’ that you'd think uncertainty was all there is.

To me, safety-netting was primarily a mind-set thing, a little voice whispering, ‘Remember you're fallible, and don't let this patient come to harm as a result.’ I hope the little voice isn't now saying, ‘Write it all down, spell it all out, and you're covered.’ No, of course it isn't; it's saying both. Isn't it?


1. Almond S, Mant D, Thompson M. Diagnostic safety-netting. Br J Gen Pract. 2009;59 DOI: 10.3399/bjgp09X472971. [PMC free article] [PubMed]

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