Decision Report 201306234

Summary

Mrs C attended at an out-of-hours (OOH) service at Monklands Hospital on two separate occasions suffering from pain across her lower back and abdomen. The OOH service provides access to GPs outwith normal working times. On the first occasion Mrs C was diagnosed with a possible abdominal aortic aneurism (a weak point in the large artery that carries blood from the heart, causing it to balloon out) or lower abdominal pain with an unknown cause. She was referred directly to a surgeon at the hospital. Tests ruled out an aneurism and Mrs C was sent home with antibiotics for a urinary tract infection.

On the second occasion, just over a month later, two potential diagnoses were recorded, renal colic (pain caused by kidney stones) or a possible pelvic mass. Mrs C was given a painkilling injection, encouraged to drink lots of fluids and sent home with advice to return if her pain worsened. She was also advised to contact her own GP on the next working day to arrange an ultrasound scan of the possible mass.

After a referral from her GP, Mrs C was discovered to have an ovarian cyst (a swelling on the ovary) and was diagnosed with cancer of the left ovary. She complained that neither of the doctors who examined her admitted her to hospital for assessment and that, had this happened, the ovarian cyst would have been picked up earlier.

After taking advice on this case from one of our medical advisers, we did not uphold Mrs C's complaint. Our adviser explained that both the doctors who saw Mrs C at the OOH service provided a reasonable standard of care and that her symptoms had not been typical of ovarian cancer.

Recommendations

We recommended that the board:

• ensure that the adviser's comments regarding the management and investigation of suspected pelvic mass (including the benefit of pelvic examinations) are fed back to the relevent doctor.