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Case ref:201100784
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Date:January 2012
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Body:A Medical Practice, Highland NHS Board
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Sector:Health
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Outcome:Upheld, action taken by body to remedy, recommendations
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Subject:Clinical treatment / Diagnosis
Summary
Mrs C complained on behalf of her husband (Mr C) about the care and treatment he received from his medical practice in relation to abdominal pain. Mr C had been suffering from constipation for several months. A GP visited Mr C at home as he was unable to attend the practice because of the pain. Mrs C called the practice several times shortly after the home visit, telling two GPs that Mr C's condition was not improving despite intervention from the district nurse and treatment for constipation. The practice did not, however, arrange a further home visit during the telephone calls.
Mrs C telephoned NHS 24 and an out-of-hours GP examined Mr C and arranged an emergency admission to hospital. Mr C had an operation on the day of his admission given the seriousness of his condition. He had peritonitis and a large inflammatory mass related to the large bowel. His recovery was traumatic and he continues to experience significant health problems and chronic pain. Mrs C said that if the practice had properly followed up their initial home visit, Mr C would have been admitted to hospital earlier and might not have been so severely ill. She felt that his continuing significant health problems and chronic pain could also have been avoided.
We found that the information available to the GPs from the telephone calls and the district nurse should have prompted them to reassess Mr C in person and examine him. Having said that, our medical adviser said that it was not certain that the deterioration in Mr C's condition would have been picked up by clinical examination or whether it would have made any difference to the outcome. A home visit could, however, have improved the chances of a better outcome for Mr C. The practice have already recognised that there were failings and have taken some action to address these.
Recommendations
We recommended that the practice:
• review their processes around telephone consultations and report to the Ombudsman on the outcome of the review and the related training (that they have already planned); and
• review their management of diverticular disease.