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Decision Report 201403776

  • Case ref:
    201403776
  • Date:
    June 2015
  • Body:
    A Medical Practice in the Lanarkshire NHS Board area
  • Sector:
    Health
  • Outcome:
    Not upheld, recommendations
  • Subject:
    clinical treatment / diagnosis

Summary

Mrs C complained about the care and treatment that her husband (Mr A) received from the practice. Mr A, who had a history of anxiety, had been suffering from episodes of breathlessness. Mr A was diagnosed with panic attacks and adjustments were made to his existing anxiety medication to treat this. He was later prescribed further medication following a phone consultation and when this proved ineffective, he was seen at home as his anxiety was preventing him from going outdoors. During this visit, no abnormal findings were made during a physical examination and a referral to the community mental health team was declined. Two days later, Mr A suffered a stroke. When he was admitted to hospital, he was also found to be suffering from a chest infection. Mr A did not recover from the stroke and passed away around three weeks later.

Mrs C complained that Mr A had not been properly examined by doctors from the practice as they had failed to diagnose his chest infection. After taking independent advice from one of our GP advisers, we found that the actions taken by the practice were reasonable. Mr A's symptoms suggested that he was suffering from anxiety/panic attacks and there was no evidence that he had a chest infection at either of the consultations with doctors from the practice. We did not uphold Mrs C's complaint but made a single recommendation as a result of record-keeping issues identified during our investigation.

Recommendations

We recommended that the practice:

  • ensure the relevant GP reviews his medical record-keeping to ensure that both normal and negative findings are noted as part of normal practice.

Updated: March 13, 2018