Decision Report 201403389

Summary

Mr C, an advice worker, complained on behalf of his client (Mr A) who had injured his back at home while breaking wood. Mr A was seen at the practice and complained of pain, pins and needles, and numbness. Mr A asked for an MRI scan (magnetic resonance imaging scan), but was referred for an x-ray which raised no concerns. He continued to experience severe pain and numbness in his legs. Following further consultations at the practice he was advised to attend the local A&E department. He was admitted to hospital and diagnosed with a compressed disc which required surgery.

Mr C complained that the practice had ignored serious red flag symptoms of spinal injury on three occasions and considered that Mr A should have been referred for an MRI scan.

We took independent medical advice from one of our GP advisers, and found that the practice would not have been able to refer directly for an MRI scan. However, the GPs at the practice followed the wrong diagnostic pathway and, as such, failed to identify three red flag symptoms. We concluded that, had the correct pathway been followed, Mr A would have been referred urgently to a specialist.

Recommendations

We recommended that the practice:

• apologise to Mr A for failing to make the appropriate referral during his initial consultations; and
• ensure that all the practitioners involved in reviewing Mr A in this case undertake a review of their practice in relation to management of patients with lower back pain. This should include familiarising themselves with the scope of the relevant Pathway for Management of Lower Back Pain referred to in our decision.