Decision report 201200327

Summary

Ms C complained about the treatment her mother (Mrs A) received from a GP at her medical practice. Mrs A had attended an appointment with the GP in relation to rectal pain and bleeding. The GP performed an examination, diagnosed piles, prescribed a treatment, and advised Mrs A to return within seven to ten days if her symptoms did not improve. Mrs A returned some five weeks later, by which time her symptoms had worsened and she had blood in her stools. Another GP referred Mrs A to hospital for tests, and she was given a clinic appointment for just over two months later. In the meantime, Mrs A attended the practice on two further occasions, when she was seen again by the first GP. On one of these occasions, the GP physically examined Mrs A again.

Mrs A was diagnosed with colorectal (bowel) cancer after the hospital appointment. She underwent chemotherapy and radiotherapy. Due to other medical conditions, it was considered that surgery was not a suitable option and Mrs A died just under a year and a half after being diagnosed. Ms C said that if the GP had properly recognised her mother's symptoms at the start, she might have had a better life expectancy and an improved quality of life. Ms C was also concerned that, given the subsequent cancer diagnosis, the GP had said that there was 'nothing untoward' on the occasions that she examined Mrs A.

Having taken independent advice from one of our medical advisers, we found that the GP's care of Mrs A had been appropriate. We found that it was reasonable for the GP to prescribe medication for piles at the first appointment, and to advise Mrs A to attend seven to ten days later if her symptoms had not improved. We accepted that the referral was appropriate, and that there was no requirement for the GP to try to speed that up after Mrs A's later appointments. We noted that, as a hospital appointment had already been made and was due shortly, this would have had no practical impact upon Mrs A's prognosis and treatment time. We also found that the GP's statement that there had been 'nothing untoward' was made in the context of the physical examinations. It was reasonable that further tests at the hospital were needed in order to discover a cancer diagnosis.

We did draw to the practice's attention that it might have given Ms C some reassurance if they had told her that they had carried out a Significant Event Analysis (a detailed investigation into what happened) as a direct result of her complaint, and had put in place the learning outcomes that it identified.