Decision Report 201302816

Summary

Mrs C attended the medical practice as she had a swollen, discoloured and painful varicose vein in her right leg. She was initially seen by the practice nurse, who prescribed antibiotics (drugs to treat bacterial infection) and anti-inflammatory medication after consulting one of the practice doctors. The following day, as Mrs C’s leg continued to be very painful, she again phoned the practice and was advised by one of the doctors that she had not allowed enough time for the medication to work. Over the next 12 days, Mrs C was visited at home twice, as she felt she was not improving. On the afternoon of the second home visit, the doctor who visited Mrs C arranged for her to be seen by a vascular specialist at hospital. Mrs C requested an ambulance to take her there. She was offered a non-emergency ambulance but due to the possibility she might wait a number of hours for it and miss the appointment, the practice told her that she might wish to make her own travel arrangements, which she did. At the hospital, an ultrasound scan of Mrs C's right leg revealed a blood clot from the ankle to the groin, and she required emergency surgery. Mrs C was admitted to hospital the same day and discharged several days later.

Mrs C complained that the practice failed to appropriately assess and treat her symptoms, and that she should not have had to make her own way to the hospital. She was dissatisfied with the explanations provided by the practice and the way in which they dealt with her concerns and complained to us, saying that she had no faith in them.

We took independent advice on this case from one of our medical advisers. The advice, which we accepted, was that the practice had not failed in their care of Mrs C. Indeed, the adviser considered the prompt referral of Mrs C to a vascular surgeon was evidence of excellent practice. The adviser also said that Mrs C did not need an emergency ambulance to take her to hospital and the reason that she was given as to why she might wish to make her own way there was reasonable. However, we also accepted that the practice may not have given Mrs C clear explanations and reassurance about her diagnosis and treatment. In addition, while there were clearly conflicting views about the reasons for the breakdown in Mrs C‘s relationship with the practice, we took the view that they should reflect on whether they had fully considered the reasons for Mrs C’s dissatisfaction and loss of faith, and how these could be resolved, particularly as she remains a patient there.

Recommendations

We recommended that the practice:

• review the way they communicate with their patients; and
• invite Mrs C to a meeting to discuss her concerns.