Summary
Mrs C complained about the care and treatment that her late mother-in-law (Mrs A) received from her medical practice over the two-year period before her death. Mrs A first contacted the practice in November 2011 about her hip pain. She was prescribed painkillers but the pain persisted, and an x-ray was taken in summer 2012 which suggested that she had osteoarthritis. Mrs A's pain increased so, in October 2012, the practice made a referral for her to see an orthopaedic consultant (who specialises in the musculoskeletal system).
In January 2013, Mrs A reported to the practice her weight loss of ten kilograms over two to three weeks. She saw the orthopaedic consultant, who thought that her pain was muscular and at the base of her spine, rather than caused by arthritis in her hip. Mrs A received physiotherapy and stronger painkillers, neither of which helped to reduce her worsening pain. She was re-referred to orthopaedics, and saw the consultant, who arranged a scan for the end of August 2013. Before the scan, Mrs A's condition deteriorated further. She was in regular contact with the practice, and prescribed different pain medications. She found the scan very painful and did not get the results in the time-frame she was expecting.
Mrs A's mobility decreased in September 2013 until she was mostly bed-bound, and a home visit from the practice was requested. The scan results showed an abnormality at the base of her spine and, in light of her deterioration, the practice arranged Mrs A's hospital admission. She was told soon after that she had widespread secondary cancer to her hip and pelvic bone area. She died in October 2013.
In investigating Mrs C's complaints, I obtained independent advice from a GP adviser. She was concerned that Mrs A's pattern of contact with the practice, her symptoms and abnormal test results should have led to a referral for an assessment for a potential underlying problem. The adviser said that Mrs A's rapid weight loss should have been investigated as it was unlikely to be only caused by nausea from her medication. The Scottish Referral Guidelines for Suspected Cancer say that unexplained or persistent weight loss of over three weeks should be referred for investigation, which did not happen. She also noted that Mrs A's haemoglobin level and liver function should have been rechecked after getting abnormal test results.
My adviser said that Mrs A's medical records showed her increased rate of contact with the practice during the two-year period before her death and, particularly, between July and September 2013. She said that the practice should have been alert to this pattern of contact. She also noted that over half of Mrs A's consultations in this period were over the telephone. She recognised the established place in patient care for telephone contact, but she felt the symptoms Mrs A described (increasing pain, reduced function and increased weight loss) meant that she needed clinical re-examination. She felt Mrs A's symptoms were sufficient for the practice to have considered an alternative diagnosis and further investigation.
In view of the clear medical advice I received about Mrs A's pattern of contact with the practice, her symptoms and her test results, I consider more could reasonably have been done by the practice to reassess her diagnosis and investigate other possible causes of her condition. I upheld this complaint and made several recommendations.
Redress and recommendations
The Ombudsman recommends that the Practice:
- (i) apologise to Mrs C for the shortcomings identified in this report; 28 October 2015
- (ii) discuss this matter as a significant event within the Practice (with particular reference to Mrs A's pattern of contacts, the number of telephone consultations and Mrs A's increasing pain and immobility prior to her hospital admission); 25 November 2015
- (iii) review and consider their use of telephone consultations to ensure they are not overly dependent on them; and 25 November 2015
- (iv) ensure they are familiar with the Scottish Referral Guidelines for Suspected Cancer and also the Scottish Intercollegiate Guidelines Network Guidance for pain management. 25 November 2015