9. Before we decide if we should conduct a detailed investigation of 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.
10. Paragraph 15 of the GMC guidance says doctors should adequately assess patients, taking account of their history and symptoms, and examine them. It also says doctors should ‘promptly provide or arrange suitable advice, investigations or treatment where necessary’
11. With regards to back pain specifically, the sciatica CKS says doctors should ask about the nature, onset and location of the pain and whether there was any trauma or. They should look for sensory or strength changes and check for any red flag symptoms (symptoms such as numbness or loss of bowel function which are caused by a serious problem with the spine).
12. The records show doctors noted Mrs G reported a two week history of lower back pain, reduced appetite, and a swollen leg. They also noted Mrs G said she had difficulty walking as much as normal and was struggling to sleep. Miss W says her grandmother also reported abdominal pain however this is not mentioned in her records.
13. Doctors established Mrs G’s back pain had come on gradually, was not due to any trauma, and was not associated with any red flag symptoms. Doctors identified swelling in both Mrs G’s legs rather than just one, and there were no documented concerns with the circulation or appearance of either leg.
14. Doctors also carried out a lower back scan and an abdominal scan to rule out other potential causes of the pain, such as spinal fracture, spinal compression or an abdominal aortic aneurysm (where the aorta, a major blood vessel, bulges and is at risk of rupturing).
15. Having considered what should happen and comparing this to the assessment that took place, we can see the doctors adequately assessed Mrs G’s back pain in line with the sciatica CKS and GMC guidance. Based on their findings, the doctors reached a diagnosis of sciatica. We next considered whether pulmonary embolism should have been diagnosed instead.
16. The PE CKS says symptoms of pulmonary embolism typically come on suddenly. Doctors should suspect pulmonary embolism if someone has shortness of breath or an increased respiratory rate, blood when coughing, pain in the chest, or signs of a blood clot in one leg (swelling in one leg, skin changes, pain, or redness). Other signs of pulmonary embolism may be a low blood pressure, low oxygen, or a fast heartbeat.
17. Our adviser says there were no signs of pulmonary embolism on 5 April. Mrs G did not have concerning symptoms in one leg, and her vital signs (breathing rate, blood pressure, heart rate and oxygen) were all normal. She also reported no blood on coughing or pain in the chest area). We therefore find there was no reason for doctors to suspect pulmonary embolism or carry out further tests for this.
18. We understand Mrs G was found to have pulmonary embolisms six weeks later. Our adviser explained it is possible they developed after she was discharged from the ED. However, there is no way for us to know this.
19. Overall, we have seen no indication anything went wrong on 5 April as the evidence shows the Trust’s assessment of Mrs G was appropriate and there were no signs of pulmonary embolism. We recognise Miss W was very concerned about her grandmother’s care, and we hope our decision brings her some comfort.