Decision Report 201304024

Summary

Ms C attended the medical practice a number of times with various symptoms including constipation, low abdominal pain, recurrent urinary symptoms and diarrhoea. She was also treated in hospital for kidney inflammation. Ms C was eventually diagnosed with pelvic inflammatory disease (PID) and said she was told that she was infertile as a result of the delay in diagnosing and treating this. She complained that the practice did not provide her with adequate care and treatment by failing to investigate her repeated symptoms and diagnose PID.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the care and treatment Ms C received was not unreasonable. The adviser said that PID is a difficult condition to diagnose, with symptoms that may also be indicative of other more common diseases, or that may not appear at all. There was nothing typical or suggestive of a diagnosis of PID in Ms C's consultation records, and the adviser agreed with the practice that Ms C did not present with a clear cut case of PID. While we did not uphold this aspect of Ms C's complaint we recommended that the practice reflect on issues raised by the adviser in relation to their record-keeping and symptom review in relation to PID.

Ms C also complained that the practice delayed in responding to her complaint. We found there was delay in their investigation of Ms C's complaint and a failure to keep her updated about the investigation.

Recommendations

We recommended that the practice:

• reflect on our adviser's comments about the lack of detailed recording of negative findings, and discuss ways to improve this;
• reflect on the learning identified in our investigation about the presence of sterile pyuria (the presence of elevated numbers of white cells in urine which appears sterile using standard culture techniques), which can be linked to PID;
• issue a written apology to Ms C for the unreasonable delay in responding to her complaint; and
• review their complaints handling guidance and training to ensure that this includes: the obligation to promptly investigate and respond to complaints; the obligation to advise the complainant of any delay, together with an explanation for the delay and an estimated time-frame for response; and where an investigation exceeds 20 days, the obligation to advise the complainant that the SPSO may be willing to consider the complaint before their investigation is concluded.