Summary
Ms C complained to us on behalf of her client (Mr A) that doctors did not reasonably diagnose that his late wife (Mrs A) had cancer. In late 2012, Mrs A had breast cancer surgery, during which an extremely large high-grade tumour was removed. She contacted the practice some seven months later complaining of back pain and spasms. She also then developed a wheeze and cough. Between 29 July 2013 and 19 August 2013 she had four telephone consultations with three GPs at the practice, who prescribed and adjusted pain relief medication, and later provided Mrs A with an inhaler. The day after the last consultation, she contacted NHS 24 because she was having problems breathing. They arranged for an out-of-hours doctor to visit, who diagnosed pneumonia and said Mrs A should contact her GP. She did this the same day, and saw another GP from her practice, who referred her straight to hospital because of her history of breast cancer. She was found to have cancerous growths and a build-up of fluid in her chest. She was admitted to hospital but died before cancer treatment could be started.
When Mr A complained to the practice they concluded that they did not identify early enough that Mrs A was as unwell as she was, and that it would have been better if she had been more fully assessed. They said that this might have been partly due to a breakdown in communications, apologised for the standard of care provided and said that they would carry out a Serious Event Analysis (SEA) of Mrs A's case. Mr A was not satisfied with this, and took the complaint further, latterly with the help of Ms C. The final outcome was that although the practice agreed that with hindsight things could have been done better, they said that they had found nothing that needed remedy.
I took independent advice from one of my medical advisers, who is a GP. She said that the medical histories taken during the telephone consultations were sparse and that Mrs A's clinical history should have made doctors suspect that the cancer might have come back. The surgeon had told the practice that it was not possible to say whether surgery had achieved a long term cure. Given all the circumstances, my adviser said that Mrs A should have been physically assessed at the time of the first call, and certainly when the pain did not resolve after painkillers were provided. My adviser had several concerns about the lack of assessment before prescribing treatments, and these are detailed in my report. She also pointed out although that the SEA report showed some evidence of reflection on and learning from Mrs A's case, the practice also appeared to have suggested that some of the responsibility lay with Mrs A for not explaining just how much pain she was in.
I upheld Ms C's complaint, as I found that a combination of errors led to an unreasonable delay in diagnosing Mrs A's condition. She should have been seen face-to-face and assessed much earlier, and elements of her care fell below General Medical Council standards. Although the practice accepted that they did not physically assess her early enough and have introduced a new telephone protocol, my adviser identified some other serious failings, especially around prescribing medication without adequate knowledge of the patient's health. I was also concerned that in handling the complaint the practice appeared to ascribe some of the blame to Mrs A, which suggests to me that they had not fully accepted that their handling of her case was not of a reasonable standard. They also appeared to minimise fault on the part of the doctors, and I found the tone of some of their letters inappropriate.
Redress and recommendations
I recommended that the Practice:
- (i) apologise to Mr A for the failure to identify the recurrence of Mrs A's cancer;
- (ii) ensure that this complaint is discussed during the next annual appraisals of GP 1, GP 2 and GP 3;
- (iii) raise awareness amongst all doctors at the Practice of the signs and symptoms of cancer recurrence; and
- (iv) refer this case to the Board for further discussion with their clinical support group to avoid a recurrence of similar events in future.