Patients often build up a relationship of trust with their GP over a number of years. It can be devastating when a GP fails in his or her duty to a patient. Our medical negligence solicitors understand this and know it can be a difficult decision to make a claim against a family GP. What do General Practitioner s (GPs) do? GPs are a patient s first port of call when accessing the health service. From a chest infection to a twisted ankle, GPs are required to deal with everything. For the majority of patients all that is required is advice and/or medication to deal with their problem. One of the key roles of a GP is to refer a patient to hospital if they believe that they need specialist or further treatment for a particular condition, for example where the GP suspects that the patient may be suffering from cancer. As GPs deal with the complete range of medical problems and conditions, this short summary cannot cover every situation. We have set out some common examples below, but whatever your concern our specialist team would be happy to discuss it with you. What are the most common complaints about GPs? Over the years we have dealt with a vast array of claims against GPs. As each patient is different, so is each claim. Nevertheless, we have come to note a number of common complaints about GPs as set out below: GP failing to visit a patient at home when asked. This can be a particular problem where the cause of the illness is not clear, for example stomach or chest pains which could indicate a more serious illness. GP failing to examine a patient or perform further investigations. GP failing to refer a patient to hospital in a timely and appropriate manner. For example a patient may have attended the GP practice repeatedly with the same symptoms and the GP has not referred the patient on to a specialist. A failure to refer to hospital by a GP can lead to a delay in diagnosing a serious condition. GP prescribing incorrect medication or the correct medication but an incorrect dose. Page 1 of 6
As well as being a cause for complaint these can be also be the reasons for a medical negligence claim. What questions have to be considered in a claim for medical negligence against a GP? In the particular circumstances: Should the GP have arranged for the patient to be seen at home? Did the GP conduct a full enough examination and take (and record) an adequate history? Should the patient have been admitted to hospital or referred to a specialist? Was it reasonable to treat the condition as the GP did? Did poor communication between doctors lead to mismanagement? Cancer claims Cancer is an emotive disease. The diagnosis is often accompanied by shock, anger, denial and depression in both the patient and their relatives. GPs will not see specific cancers very often, although overall they will often see patients with cancer. Cancers can be classified into malignant and benign, the former being more serious with a rapid cell turnover, rate of growth and metastasis. Benign tumours can be just as serious because of the space occupied by the tumour. This is particularly the case with brain tumours where the restricted space within the skull means benign tumours can cause severe and lasting damage. One of the dilemmas of any doctor is in differentiating minor symptoms from the early signs of a malignant disease. It can be easy to see a delay in referral and diagnosis of a cancer with the benefit of hindsight. However, a GP has to balance the anxiety of investigation against the dangers of a missed diagnosis. In general terms, early diagnosis will offer the opportunity of early treatment and often this will improve prognosis, but this is not always so. Every case will need careful consideration. Page 2 of 6
If you or a loved one are affected by cancer, you may wish to read our guide to cancer claims at www.lawyers4patients.co.uk. Fractures If a patient attends the GP practice with the following signs and symptoms, the GP should consider whether they have suffered a fracture:- Deformity that can be seen or felt. Local swelling. Bruising. Local tenderness over bone. Loss of function (difficulty moving joint or using limb). Abnormal mobility (unable to stand or walk). Grating when the injured part is moved. If a GP suspects that a patient may have suffered a fracture they should refer them to the nearest Accident & Emergency Department for an x-ray. If this issue affects you, you may also like to read our guide to fracture claims at www.lawyers4patients.co.uk. Back Pain Over the course of a lifetime the vast majority of people will suffer from backache at one time or another. If a person attends their GP practice for backache it may usually be treated with, amongst other things, rest, physiotherapy, painkillers and/or anti-inflammatory medication. Sometimes, however, it is necessary to refer a patient to hospital. Symptoms that suggest the need for a referral are:- Under 20 or over 60 years of age. Previous history of any cancer. Significant traumatic injury. Inflammatory disorders. Past or present use of systemic steroids. Persistent restriction in lumbar (lower back) movement. Page 3 of 6
Symptoms that require an urgent referral to a specialist are: Bladder or bowel disturbance. Persistent severe pain despite treatment over 2 weeks. Progressive neurological signs, such as foot drop. Signs of loss of power. If you have been affected by spinal surgery, you may also wish to read our guide on Spinal Surgery claims. Sudden Loss of Vision - Retinal Detachment When a person has problems with their eyesight they will often attend their optician first. The eye test is conducted by an optometrist with an optician dispensing spectacles or contact lenses if appropriate. If an optometrist notices that something is wrong often they will refer the patient to their GP to take further action. This may be something that can be dealt with by the GP, such as infection, or may require a referral to a Consultant Ophthalmologist at the hospital, for example if someone is starting to suffer from cataracts. Again, it is incumbent on the GP to recognise if the patient has a condition that requires immediate referral to a specialist centre at the hospital. One of the conditions that would warrant an immediate referral to the hospital would be retinal detachment. The retina is the light-sensitive layer at the back of the eye which is vital for eyesight. Sudden loss of vision is a serious and urgent matter requiring immediate intervention. Any patient attending the GP with painless, sudden loss of vision should be referred immediately to an ophthalmologist for diagnosis and treatment if there is to be any chance of saving the patient s sight. Retinal detachment is a possible cause of sudden loss of vision. The patient must be referred to hospital immediately as it may be necessary to undergo emergency surgery in order to save the sight in the eye. For more information on retinal detachment please see our guide to eye surgery and eyerelated claims. Page 4 of 6
Ectopic Pregnancy An ectopic pregnancy occurs when the fertilised egg develops outside the uterus (womb), most often in the fallopian tube. Patients complain of cramp-like, colicky pain, usually on one side of the abdomen. It can be confused with appendicitis. The pain is severe and is worse when moving. A diagnosis of ectopic pregnancy should be considered if a patient has vaginal bleeding and is possibly in the early stages of pregnancy with abdominal pain. If a woman of reproductive age attends her GP with unexplained abdominal pain the GP must consider that she may be suffering from an ectopic pregnancy unless proven otherwise. If an ectopic pregnancy is suspected the patient must be referred to hospital immediately because if the foetus is allowed to develop outside the womb it can lead to a rupture of the fallopian tube which can be fatal. Acute Pancreatitis If a patient complains of severe abdominal pain (which radiates down the back), feeling sick, retching and vomiting a GP should consider whether they may be suffering from acute pancreatitis. Acute pancreatitis is a serious condition which can be fatal if untreated. If acute pancreatitis is suspected the patient should be referred to hospital. Torsion of the Testicle Pain in the testicle is a potentially serious condition. It could be caused by torsion of the testicle (testis), where the cord is twisted and cuts off the blood supply. It is more common during the first year of life and during puberty. There is a sudden onset of pain (but can be more gradual in children) on one side. The testicle is hot, swollen and tender. The condition requires urgent treatment because loss of blood supply for 6 hours may result in gangrene so that the testicle will have to be removed. Surgical correction in 5 hours of the onset of symptoms may save the testicle. Page 5 of 6
If a GP suspects that a patient may be suffering from torsion of the testicle it is vital that they act quickly and refer them to hospital immediately so that emergency surgery can be conducted if necessary. Prescriptions When issuing a prescription the GP should make a diagnosis and choose a drug that is needed, effective to treat the condition, cost effective and with an acceptable risk. The GP should discuss the drug with the patient and warn of common side effects and adverse reactions. The dosage, frequency and duration of the treatment should be clearly understood and agreed. When deciding whether the medication is needed it is important that the GP is confident that it was within his or her field of expertise to diagnose that condition. Certain conditions may need to be confirmed by a specialist within a hospital. If that is the case then the GP should not prescribe medication until he or she has been directed by the hospital to do so. Repeat Prescriptions GPs issue repeat prescriptions without seeing the patient. The patient should be reviewed periodically, with the frequency of the review being determined by their condition. The GP should monitor the repeat prescriptions for overuse and under use. As you can see, the spectrum of medical negligence claims that can be made against GPs is very wide and this page is solely meant as an overview. There are many other conditions not covered above. If you believe that you may have a potential claim against your GP please contact our specialist team who would be happy to discuss any concerns that you may have regarding your treatment. Page 6 of 6