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Mr B was a 29-year-old man with depression. He saw his GP, Dr H, regularly and was prescribed antidepressant medication, which was helping. His consultations would often be long, as he discussed his feelings at length. Over the next few weeks Mr B was bothered by unilateral earache and mentioned this to Dr H, who examined his ear. Dr H said it looked healthy and gave reassuring advice. However, rather than improving, Mr B’s earache seemed to be getting worse and was waking him at night. He explained this to Dr H on a subsequent visit. Dr H put his sleep disturbance down to low mood and again reassured him about his earache. The GP thought this was a reflection of his depression and discussed increasing his antidepressant medication. Mr B saw several different GPs about his earache over the next few weeks – it had become a constant, nagging pain. Minimal examination notes suggested otitis externa, for which he was given a steroid spray, and otitis media, for which he received three different types of antibiotic. Mr B was rather distressed about his earache and felt tired. The GPs thought this was a reflection of his depression and discussed increasing his antidepressant medication. Shortly after, Mr B developed left-sided nasal congestion and an aching sensation in his neck on the same side. He was seen by Dr H again, who thought he was run-down and that focusing on his health in a negative way could be part of his depression. The most frightening thing for Mr B was that he became aware of swallowing difficulties. He had had one choking episode so had changed his diet to eat softer foods. He noticed that he was losing weight and feeling tired all the time. He made another appointment with Dr H to discuss this. Dr H made a record that no abnormalities had been found on examination, but this did not include any record of a cranial nerve examination. Dr H attributed his symptoms of tiredness, generalised weakness and weight loss to his low mood. After eight months of GP appointments, Mr B attended his local emergency department because he was feeling so unwell. He had a CT followed by an MRI scan and was quickly diagnosed with a large destructive mass centred on the left naso-pharynx and skull base, eroding bone and spreading into the anterior pituitary fossa. The tumour was found to be a low-grade adenocarcinoma. Mr B was given palliative radiotherapy, which relieved some of the pain for a time, but the prognosis was terminal. Mr B was very upset and angry and made a claim against his GPs.