Sherwood Forest Hospitals NHS Foundation Trust

3. Mr N has raised a complaint about an appointment with a consultant orthopaedic surgeon at the Trust on 24 May 2021. His complaint is that: · he feels the consultant was rude · he disputes the consultant’s view that he was ‘threatening’ · he believes the consultant misdiagnosed his foot issue and incorrectly located the cause of his pain.

4. Mr N says: · he is concerned the consultant told his GP he was threatening, and this may be on his medical record which could affect his future care · he was left in significant pain and the consultant’s actions delayed him getting treatment · he was not able to get a cortisone (pain relief) injection due to the consultant’s comments about the cause of his pain.

5. To resolve the complaint Mr N would like: · to ensure his record does not say he was threatening, or for the consultant to rectify their comments · answers to what is wrong with his foot · treatment for his foot condition.

6. Mr N began experiencing pain in his toe and foot in January 2021. He explained he is on his feet most of the day for work and this becomes uncomfortable. Mr N had an ultrasound in January 2021.

7. Mr N attended an appointment on 7 May 2021 where the clinician discussed the ultrasound results, gave their view there was no need for an injection and referred Mr N on for a consultant opinion. The physiotherapist highlighted fluid in the peroneal tendon (which runs from the outside of the leg, around the back of the ankle to the outside of the foot) but stated that all the symptoms Mr N reported were medial (linked to the ligaments that attaches the ankle to the inside of the foot).

8. Mr N spoke to a consultant orthopaedic surgeon (the consultant) at the Trust on 24 May 2021. The consultant was unable to give a definitive diagnosis during the appointment. They discussed the peroneal tendon. The clinic letter indicates the consultant felt there was no swelling or tenderness over the peroneal tendon area.

9. Mr N was not happy with the consultant’s explanation and did not believe what the consultant said was correct. The consultant felt that further investigations were required and arranged for testing.

10. Mr N felt that the consultant was rude and pointed in his face during the meeting. The consultant used the word ‘threatening’ when describing Mr N’s actions in their write up of the appointment.

11. Mr N says the incorrect information noted by the consultant during this appointment affected later treatment and diagnosis. He says he was unable to get a cortisone injection as the consultant had highlighted the wrong area as the cause of his pain.

The consultant’s attitude

16. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this, and we have not found any indications that something has gone wrong.

17. GMC guidance says clinicians should record their work accurately and must be polite and considerate.

18. Mr N told us that he was unhappy with his interaction with the consultant at his appointment on 24 May 2021. Mr N felt the consultant was rude and pointed their finger in his face. He explained this caused him a lot of frustration.

19. In the Trust’s response, the consultant explained that they never intended to cause offense and was trying to point out the tendons on Mr N’s foot. They apologised for the misunderstanding.

20. There was a physiotherapist present during this interaction, and we have considered their notes on what happened.

21. The physiotherapist’s interpretation of events was that the consultant was, ‘pointing at pt’s [patient’s] foot to describe where the peroneal tendons are and gesticulating while explaining’. They also confirm the consultant apologised for the misunderstanding at the time. This gives weight to the consultant’s explanation that they were not intending to point in Mr N’s face.

22. We have considered the accounts of all three people present at the time and our view is that there was a misunderstanding between Mr N and the consultant. Based on the information we have seen, we do not feel it is likely the consultant would have intended to be rude.

23. We can see they apologised and explained the reasons for the misunderstanding, both at the time and in the complaint response. We do acknowledge that Mr N found this appointment to be upsetting.

24. We have seen no indication the consultant failed to act in line with GMC guidance and will take no further action on this point.

The consultant’s entry in the medical records

25. Mr N is unhappy with the consultant’s write up of the appointment, which was sent to his GP, and uses the word ‘threatening’ to describe Mr N’s actions. Mr N is concerned this will be on his NHS record and would like this to be removed or amended. We know he is concerned that his future care may be affected if other clinicians were to read this.

26. The Trust said in its response that the consultant did not intend to cause upset or confrontation.

27. We may decide not to investigate a complaint further if we cannot achieve the outcomes that the complainant wants. To resolve this aspect of his complaint, Mr N would like us to remove the reference to him being threatening from his medical records.

28. We do not have the power to amend medical records or ask for the Trust to amend the records. While we understand how this reference might impact on Mr N, we would not be able to achieve a satisfactory outcome for him. We consider that Mr N should contact the Trust directly if would like to request a change to his records.

29. We will therefore not take any further action on this part of his complaint.

Misdiagnosis of foot pain

30. GMC guidance says that clinicians must adequately assess patients and arrange for investigations where necessary.

31. Mr N believes that the consultant misdiagnosed his foot issue and gave him incorrect information about where the tendon is located. He says this prevented him from receiving treatment.

32. We have sympathy for Mr N’s situation as he had been in pain for several months and had been waiting for a diagnosis to explain his pain.

33. In its complaint responses, the Trust explained that the peroneal tendon runs down the back of the leg and ankle. It apologised for any misunderstanding or if this was not explained clearly enough in the meeting. The consultant explained, following the appointment, they did not have enough information to make a diagnosis and Mr N needed further testing.

34. We can see from the consultant’s letter about the appointment that they considered a range of factors. They discussed with Mr N his history with the problem, conducted a clinical examination of the foot and ankle and considered the ultrasound from January 2021. Our adviser explained this was in line with GMC guidance.

35. Following the appointment the consultant wrote, ‘an ultrasound scan performed 13.01.21 reports some excess fluid around the peroneal tendons consistent with peroneal tenosynovitis [swelling and inflammation of the peroneal tendons' coverings] although there are no clinical features suggesting this.’ This shows us they considered the evidence and Mr N’s presentation but was unable to come to a firm conclusion.

36. As the consultant was unable to make a diagnosis based off the information they considered, they arranged further tests. Our adviser felt that as the findings from the assessment did not correlate with the ultrasound, the consultant acted in line with GMC guidance in arranging for further testing.

37. Following our analysis of the records and our adviser’s view, we consider that the consultant carefully considered Mr N’s symptoms. We feel that they acted in line with GMC guidance by requested further testing.

38. Mr N says explained he should have had a cortisone injection to the outside of his foot to help with the pain. We can see on 25 May 2021, the Trust explained to Mr N that the pain was on the inside, and it would not inject a pain free area. The Trust’s explanation appears supported by the available evidence (and to in line with GMC guidance) as the Trust was still trying to establish what was causing his pain and where it was coming from. We understand how disappointing this would have been for Mr N having waited for an appointment to then be told treatment could not be given.

39. Mr N believes the consultant incorrectly advised him where the tendons were. Mr N has been told that the tendons are on the right of the foot rather than on the back, as the consultant explained.

40. In their write up of the appointment the consultant clarifies, ‘I explained that usually peroneal problems present with pain and swelling on the back of the fibula’. In the complaint response the consultant clarifies that the tendons are located behind the fibula which run on the right side of the leg to the ankle joint. This explanation is in line with our understanding of the peroneal tendon.

41. Having considered the evidence, we take the view that the consultant assessed Mr N in line with guidance. The consultant was unable to diagnose the cause of Mr N’s pain and their explanation of the location of the tendon was correct. It was reasonable for the consultant to arrange further testing for Mr N before giving treatment.

42. We have seen no indications that something has gone wrong with Mr N’s care, and we will not take any further action on his complaint.

1. We have carefully considered Mr N’s complaint about Sherwood Forest Hospitals NHS Foundation Trust (the Trust). Mr N has explained how he has been suffering with pain in his foot and toe and we were sorry to hear how uncomfortable this has been for him.

2. We have seen no indications that anything went seriously wrong, either in terms of Mr N’s interactions with the consultant, or the information in his medical records.