Expert Witness Journal Issue 67 June/July 2026 - Flipbook - Page 43
Evidential Gaps in Primary Care
Communication: When “Usual Practice”
Is Not Enough — Expert GP Analysis of
Shaheen and Ahmed v Daish
by Dr Samah Boulis, GP Expert Witness.
treated with inhalers and oral steroids, and a
chest X-ray was requested via the ICE system. This
operated as a walk-in service requiring the patient
to attend radiology independently.
Clinical negligence cases in primary care rarely
turn on dramatic errors. More often, they hinge on
small, easily overlooked moments within routine
consultations. The High Court decision in Shaheen
and Ahmed (Executors of the Estate of Mr Ajaz Ahmed) v
Dr Joanna Daish is a clear illustration of this reality.
The key chronology is as follows:
At its core, this case is not about diagnostic failure
in the traditional sense. It is about communication—
what was said, what was not said, and, crucially, what
cannot be proven to have been said. For those of
us practising as GP expert witnesses, it represents
a clear and instructive example of how work昀氀ow,
documentation, and patient-led systems intersect to
create medicolegal risk.
•
11 February 2019: Consultation recorded
examination, diagnosis, treatment, and the X-ray
request. However, there was no documentation
of any discussion with the patient about the
investigation or how to access it. Audit data
indicated that parts of the management plan,
including prescribing, were completed after the
patient had left, and the record was then closed.
•
11 February 2019 (later): A text message was
sent regarding medication changes only; no
communication was sent about the X-ray.
•
27 February 2019: A nurse follow-up appointment
was scheduled but not attended, with no clear
link to imaging.
Factual Background and Chronology
Mr Ahmed, aged 49, consulted his GP, Dr Daish,
on 11 February 2019 with worsening breathlessness
following a respiratory infection. At consultation,
he was assessed as having an asthma exacerbation,
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