• Report no:
    201800708
  • Date:
    October 2018
  • Body:
    A Medical Practice in the Fife NHS Board area
  • Sector(s):
    Health

Summary

Ms C complained about the care and treatment provided to her late partner (Mr A) by their GP practice (the Practice) prior to his diagnosis of non-small-cell lung cancer stage 3 (advanced cancer).

Mr A had attended the Practice on a number of occasions during a five month period with symptoms of unresolving shoulder pain.  Ms C said Mr A had seen a number of GPs during the period and that a request for a CT scan was refused initially. She also said that the GPs repeatedly prescribed painkillers which were ineffective. When Mr A was finally referred for a CT scan the diagnosis of cancer was made. Ms C felt that the failure of the GPs to refer Mr A for a CT scan had led to a delay in the diagnosis of cancer.

We took independent advice from a general practitioner, which we accepted.

We found that four of the six GPs involved in Mr A's care and treatment had failed to take appropriate action in an effort to determine the cause of Mr A's shoulder pain. Mr A's symptoms had not improved with different types of painkilling medication and after being referred for physiotherapy. A chest X-ray had been taken which was reported as normal. We found that the GPs had failed to consider the complete picture in that Mr A had attended the Practice on numerous occasions within a short timeframe and they dealt with the symptoms reported at the time of the consultations. They had not fully considered the previous consultations which would have allowed them to be better informed of the situation.

We also found that one of the GPs involved had incorrectly advised Mr A that he absolutely did not have cancer, which was an inaccurate statement to have made as at that stage a specialist opinion had not been obtained. This would have given Mr A false reassurance.

We also found that two of the GPs involved in Mr A's care took appropriate action when considering Mr A's reported symptoms and proposed reasonable investigations in an effort to reach a diagnosis.

We upheld Ms C's complaint.

Redress and Recommendations
The Ombudsman's recommendations are set out below:

What we are asking the Practice to do for Ms C:

What we found

What the organisation should do

Evidence SPSO needs to check that this has happened and the deadline

There was an unreasonable delay in referring Mr A for a specialist opinion in view of his presenting symptoms

Apologise to Ms C for the failure to refer Mr A for a specialist opinion at an earlier stage

A copy or record of the apology.  The apology should meet the standards set out in the SPSO guidelines on apology available at https://www.spso.org.uk/leaflets-and-guidance

By:  21 November 2018

 

We are asking the Practice to improve the way they do things:

What we found

What should change

Evidence SPSO needs to check that this has happened and deadline

There was an unreasonable delay in referring Mr A for a specialist opinion in view of his presenting symptoms

 

 

 

 

 

Doctor 4 unreasonably gave Mr A an assurance that he definitely did not have lung cancer

 

 

 

All doctors at the Practice should be aware of the Scottish Cancer Referral Guidelines. Any doctors who were involved in the complaint and are no longer at the Practice should be made aware of and sent a copy of this report

 

 

Doctor 4 should be aware of the importance of accurate communication with patients in accordance with General Medical Council Good Medical Practice guidelines

Evidence that the findings of this case have been used as a training tool for staff and that this decision has been shared and discussed with the relevant staff in a supportive manner.  This could include minutes of discussions at a staff meeting or copies of internal memos/emails

By: 21 November 2018

Evidence that doctor 4 has reflected on their actions and that the matter has been shared and discussed with them in a supportive manner.  This could include minutes of discussions at a meeting or copies of internal memos/emails

 

By: 21 November 2018

Feedback

Points to note

As highlighted by the Adviser, the SPSO investigation notes there is evidence of good medical practice by Doctors 1 and 6 in that they took appropriate action when considering Mr A’s reported symptoms and proposed reasonable investigations in an effort to reach a diagnosis.  In reflecting on this complaint, we strongly urge the Practice to share and learn from the positive aspects of the treatment.