Not upheld, no recommendations

Summary

Mrs C complained that a GP failed to physically examine her husband (Mr C) during a home visit and wrongly concentrated on his mental health problems. The practice explained that the GP believed that Mr C was depressed and that he required a psychiatric assessment, which she arranged on return to the practice.

Our investigation found that Mr C's medical records showed that the reason for the home visit was for mental health issues rather than a physical examination. Our medical adviser reviewed the records and felt they were appropriate in relation to a visit for mental health issues. We were unable to resolve the difference of opinion between Mrs C and the GP about what was actually said at the visit, but we were satisfied that the GP's actions in making a referral for psychiatric assessment were correct.

Summary

Mrs C's daughter (Miss A) attended a GP appointment with symptoms of depression. She was prescribed Prozac (an anti-depressant medication). Mrs C complained that this treatment was inappropriate. She felt that the GP had not tried to properly establish the cause of her daughter's depression and had unreasonably prescribed medication that could increase the risk of suicide in young people.

However, after taking independent advice from one of our medical advisers, we found that the GP's treatment of Miss A was reasonable. A review appointment had been made for a week later. We found that it was appropriate to prescribe such medication for Miss A's symptoms, particularly as the review appointment was in place to assess her reaction to, and mood level, whilst taking the medication.

Summary

Mr C fell and injured his foot while on holiday. Upon returning home, he went to a hospital accident and emergency department (A&E) where his foot was x-rayed. He was told that this showed no problems, but he continued to experience severe pain in the following months. Some six months later, Mr C's GP referred him for further x-rays, which showed that he had a dislocated toe. He was told that, because of the amount of time that had passed, this could not be corrected without surgery. Mr C complained that staff failed to identify the dislocation when reviewing the earlier x-rays.

When investigating Mr C's complaint, the board asked a panel of six consultant radiologists (specialists in analysing images of the body) to review the x-rays. They concluded that the dislocation was not evident on the original x-rays and that Mr C's toe joint must have separated between then and the referral, when the dislocation was obvious. Mr C's consultant orthopaedic surgeon (a specialist in conditions involving the musculoskeletal system) also reviewed the x-rays. He concluded that a slight abnormality was evident on the original x-rays, but did not feel that it was reasonable to expect staff to have diagnosed a dislocation from this at the time, as it was only apparent when comparing the image to the March 2012 x-ray.

We took independent advice from two medical advisers. The first, a consultant radiologist, said that the original x-rays showed a subtle but definite abnormality, which should have led to the dislocation being diagnosed, or to further specialist opinion being sought. However, the second adviser, a consultant orthopaedic surgeon, disagreed and did not consider that staff could reasonably have been expected to diagnose the dislocation at the earlier time.

We did not uphold Mr C's complaint. We found it likely that Mr C's toe had a dislocation when he went to A&E. However, it was clear from the conclusions reached by a number of professional medical personnel that this was not easy to diagnose from the initial x-rays. Although, with the benefit of hindsight and the later x-ray, it was possible to determine that there were abnormalities in the initial x-rays, we considered that the original conclusions reached were reasonable, based on the evidence available at the time.

Summary

Miss C complained that, when she visited her GP as a new patient, he refused to prescribe her Zopiclone (a drug used to treat sleeping problems). She said she had been unable to sleep because she had been in a hypomanic stage (a period of mild over-active, excited behaviour) of her bipolar disorder (a condition that affects a person's mood) for the last two months. From previous use, she said she knew that Zopiclone would help. She told the GP that her former GP and her psychiatrist found this acceptable.

Our investigation found that the GP had been right to be cautious as Zopiclone is a drug that must be prescribed with care. For example, it is a drug that is open to abuse as a so-called street drug. Also, Miss C's medical records had not yet arrived, so the GP's knowledge of her was very limited. He did prescribe alternative medication, so there is no question that she was given nothing to help with her condition. The GP then contacted her former GP and her psychiatrist and, having been reassured by some of the information from them, prescribed the Zopiclone the next day. Our independent medical adviser considered that this was a very reasonable approach and we did not uphold Miss C's complaint.

Summary

Mr C complained that GPs at the practice failed to take appropriate action after he repeatedly went there with back pain. The practice gave him pain relief, and offered physiotherapy. After he was admitted to a hospital accident and emergency department, magnetic resonance imaging (MRI scan - used to diagnose health conditions that affect organs, tissue and bone) was carried out, the result of which suggested an abnormality. On further investigation Mr C was found to be suffering from miliary tuberculosis (a form of bacterial lung infection which has spread to other organs).

We reviewed all Mr C's correspondence and obtained background correspondence and a copy of medical records from the practice. We also took independent advice from one of our medical advisers. He found that the practice's actions had been appropriate. The adviser confirmed the practice had followed guidelines in relation to the management and treatment of Mr C's back pain. He also explained that the diagnosis was rare and it was reasonable that the practice had not diagnosed it.

Summary

Ms C complained that staff at a physiotherapy department failed to adequately manage her symptoms of severe back pain and limited mobility. Staff initially examined her and determined that she should be given conservative management (medical treatment avoiding radical therapeutic measures or operative procedures) of her pain with physiotherapy and acupuncture before she was referred for a magnetic resonance imaging scan (MRI - a scan used to diagnose health conditions that affect organs, tissue and bone). She then had a number of appointments with a physiotherapist and acupuncture was arranged. Ms C felt that her pain had continued to get worse. She then elected to have an MRI scan carried out privately. The scan showed that a surgical procedure was needed, and Ms C had this procedure privately.

Ms C complained that the physiotherapist did not refer her for an MRI scan. We took independent advice from one of our medical advisers who specialises in physiotherapy. She reviewed the board's policy for referral for an MRI scan and Ms C's clinical records. The adviser said that the treatment Ms C received was appropriate and that it was reasonable that she was not referred earlier for an MRI scan. She also confirmed that the physiotherapist followed the appropriate protocol for referring Ms C.

Summary

Miss C complained that GPs failed to carry out appropriate investigations into the symptoms her late mother (Mrs A) was presenting with from November 2010. Mrs A was diagnosed with lung cancer in May 2011 and died in August 2011. Before she was diagnosed, Mrs A had been treated and monitored for breathlessness which was not resolving with the treatment provided. The family told us that they felt that the GPs were treating Mrs A as if her symptoms were psychological and that as a result there was a delay in diagnosing the cancer.

When Mrs A (who was a smoker) first complained of breathlessness, various tests were carried out. Her chest x-ray and blood tests were reported as being normal. Mrs A continued to suffer breathlessness, however, and was reviewed regularly in the practice by the nurse. She was also seen by GPs and the

out-of-hours service. In March 2011 Mrs A was diagnosed with a chest infection and prescribed antibiotics (drugs to treat bacterial infection). When the condition persisted, she was referred for a further chest x-ray. This x-ray was reported as abnormal and Mrs A was referred urgently for a CT scan (a special scan which uses a computer to produce an image of the body), after which she was diagnosed with lung cancer.

Our investigation, which included taking independent advice from a medical adviser, found that the care and treatment provided to Mrs A was reasonable, and in line with the national and local guidance on investigating, managing and treating lung cancer. Although Mrs A had been referred for counselling from the community psychiatric nurse, we found no evidence that the GPs considered Mrs A's symptoms were psychological. The adviser said that the GPs clearly took note of Mrs A's physical symptoms and investigated them in a reasonable and timely manner, and in line with national guidance.

Summary

Mr C complained about a wide range of issues concerning aspects of his mental health care by the board over a number of years. However, on investigation, we considered that the board had done all they could reasonably have been expected to do in respect of his mental health. For example, he had been seen by a number of appropriate clinicians, there had been very thorough assessments, and he had had appropriate treatment. We acknowledged that Mr C wanted more from the board but were satisfied that the board could not reasonably have been expected to have provided more.

Summary

Mrs C complained that her mother (Mrs A) had mobility problems, which caused her great difficulty in attending the medical practice. Mrs C wanted an assurance that the GPs would make non-emergency home visits to Mrs A if required. The practice explained that there would have to be a clinical need for a GP to make a home visit and that they thought that Mrs A could manage to attend the practice.

Our investigation found that on one occasion when a home visit was requested, a GP did attend. However, the following week a home visit was requested and a GP refused to attend as there was no clinical need and said that Mrs A would have to attend the practice. We did not uphold the complaint but we found that the GP should have involved Mrs A more in the discussions rather than correspond with Mrs C.

Summary

Mr C complained about the care and treatment that his late wife (Mrs C) received at the medical practice over a three month period. Mr C was unhappy that the practice did not carry out relevant investigations of Mrs C's persistent and severe abdominal pain. He told us that he felt that doctors at the practice did not listen to their concerns, and that there was a lack of support. After Mrs C was admitted to hospital, further investigations showed that she had pancreatic cancer, and Mrs C died a few weeks later.

We did not, however, uphold Mr C's complaint. Our investigation found clear evidence to show that the practice had carried out appropriate and reasonable investigations to try to diagnose the cause of Mrs C's ongoing pain. They had also referred Mrs C to a specialist for further investigation. We noted that a CT scan (a special scan using a computer to produce an image of the body) had been carried out two months before her diagnosis, but had not shown any abnormalities. Our independent medical adviser also explained that pancreatic cancer tends to present late, often with non-specific symptoms, and has some of the lowest survival rates of all cancers.