Treatment and discharge
18. Mr Y says his son was inappropriately discharged without treatment in November 2022. Mr Y says as the Trust discharged his son without treatment, he is still suffering from pain and discomfort and this impacts his schoolwork, playing sports, fitness and his wellbeing.
19. We will now consider if the Trust adequately investigated Mr Y’s son’s shoulder pain and whether it inappropriately discharged him from the MSK service in November 2022.
20. From Mr Y’s son’s medical records, we can see he was referred to the Trust’s MSK service by his GP due to ongoing shoulder pain on 25 March 2022.
21. We can see Mr Y’s son had an initial consultation with an orthopaedic and physiotherapist at the Trust on 11 May. The NICE guidelines ‘Shoulder pain’ provides guidance on the assessment and management of shoulder pain in patients aged 16 and over.
22. The guidelines say an assessment of a person with shoulder pain involves taking a history and performing an examination of the shoulders. From Mr Y’s son’s medical records, we can see a full history of Mr Y’s son’s condition and shoulder issues were considered by the consultant and physiotherapist.
23. We can also see there was an assessment of Mr Y’s son’s shoulder girdle, spine, muscles, range of movement, palpation, strength, stability and rhythm of the joints, and a nerve test. Our adviser said this was an appropriate assessment and was in accordance with NICE guidelines on shoulder pain.
24. Our adviser said no significant abnormalities or causes for Mr Y’s son’s shoulder pain were found during the consultation on 11 May.
25. The GMC’s ‘Good Medical Practice’ sets out the standards expected by all clinicians. Section 15b says clinicians should promptly provide or arrange suitable advice, investigations, or treatment where necessary.
26. From Mr Y’s son’s medical records, we can see he was referred for an MRI scan for further investigation of his shoulder pain following the consultation on 11 May. This was a suitable investigation in line with ‘Good Medical Practice’.
27. From Mr Y’s son’s medical records, we can see he attended a further consultation with the orthopaedic consultant to discuss his MRI scan results on 24 August. Our adviser said Mr Y’s son’s MRI results were normal and there appeared to be no structural cause for his shoulder pain.
28. We can see Mr Y’s son’s case was discussed between a consultant orthopaedic and physiotherapist who were both in agreement there was no further intervention required by the MSK team.
29. From Mr Y’s son’s medical records, we can see he was discharged from the MSK service in November 2022. We understand why Mr Y had cause for concern about his son’s discharge.
30. Our adviser said as there was no indication of any musculoskeletal cause for Mr Y’s son’s pain, no musculoskeletal treatment could be offered, it was therefore appropriate to discharge him from the service.
31. Having reviewed all the available evidence, we consider the Trust adequately investigated Mr Y’s son’s symptoms and made an appropriate discharge.
Private diagnosis
32. Mr Y says the Trust did not accept a private osteopath and private physio opinions on Mr Y’s son’s condition. We were sad to learn a private osteopath diagnosed Mr Y’s son with hypertonic diaphragm.
33. We will now consider if the Trust should have accepted the diagnosis of hypertonic diaphragm from the private osteopath. Our adviser said hypertonic diaphragm refers to a tight or overactive diaphragm.
34. As we have previously explained, Mr Y’s son’s shoulder pain was adequately investigated in line with NICE guidelines by the Trust’s MSK team who found no musculoskeletal causes for his shoulder pain.
35. We therefore would not expect the Trust to accept the opinion of a private osteopath, when its own clinicians had already made appropriate investigations in line with clinical guidelines.
36. Our adviser explained hypertonic diaphragm would not generally be within an MSK physiotherapist or orthopaedics’ scope of practice. Our adviser said hypertonic diaphragm is more commonly used in osteopathy and would therefore be within an osteopath’s scope for management of such a condition.
37. The HCPC ‘Standards of proficiency for physiotherapists’ is the standards of proficiency expected by all physiotherapists.
38. Section 4 of the standards say physiotherapists must practice as autonomous professionals making their own professional judgments, recognise they are personably responsible for and must be able to justify their own decisions, use their own skills and knowledge to make informed decisions.
39. We therefore consider physiotherapists to be autonomous professionals who exercise their own independent judgement, and any treatment given by a professional would need to be based on assessments made by the professional providing the treatment.
40. We therefore do not consider the Trust was under any obligation to accept the report or diagnosis from the private osteopath or physiotherapist.
Conclusion
41. We hope we have clearly explained the reasons for our decision regarding the concerns Mr Y has raised and where possible reassure him with our explanation of the care provided by the Trust.
42. We would like to thank Mr Y for giving us the opportunity to consider his complaint.