11. 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. We have done this and have not seen any indication that something has gone wrong.
Clear information on the recorded skin condition
12. Mr L complains the Practice did not provide clear information as to why only part of his skin condition is being recorded on his medical records. He believes the full diagnosis, including Chronic Cutaneous T-cell Lymphoma, should be recorded.
13. GMC guidance states medical professionals must make sure that the information they give patients is clear and accurate. It also says formal records should be clear and accurate, and should include relevant clinical findings.
14. A letter from dermatology in the middle of 2011 said a diagnosis of psoriasis (a skin condition that causes flaky patches of skin which form scales) was likely.
15. The next recorded entry is from late 2012. The dermatologist diagnosed Mr L with Generalised Psoriasis (severe psoriasis) and possible Ichthyosiform (group of skin conditions) which may be congenital.
16. In 2013, the dermatologist records a probable diagnosis of probable Desquamative Dermatitis or Pityriasis Rubra Pilaris. Desquamative Dermatitis is a skin condition which is characterised by widespread redness and peeling of the skin. Pityriasis Rubra Pilaris is a skin condition which is characterised by reddish-orange scaling patches with defined borders.
17. The last recorded contact between Mr L and the dermatology department was in early 2014. The diagnosis recorded in this letter is said to be ‘?Desquamative Dermatitis and ?Chronic Cutaneous T-Cell Lymphoma or Pityriasis Rubra Pilaris’. Chronic Cutaneous T-Cell Lymphoma causes itchy, scaly rashes, round patches, or bumps that can thicken to form lesions or tumours.
18. The Practice explained this entry indicates the diagnosis of Desquamative Dermatitis and Chronic Cutaneous T-Cell Lymphoma was probable but unconfirmed at that time.
19. The Practice explained to Mr L it was unable to record a specific clinical diagnosis in his medical records without it being confirmed by a specialist first. It provided Mr L with information on what to do if he would like confirmation of a medical diagnosis. It also provided him with an option of the Practice making a referral to the dermatology department.
20. From the Practice response, we can see it clearly explained why only part of his skin condition is recorded and not the full diagnosis including Chronic Cutaneous T-Cell Lymphoma. This is because the condition was unconfirmed and could not be recorded until a specialist confirmed the diagnosis.
21. We acknowledge the distress Mr L experienced in relation to the recording of his skin condition. We think the Practice acted in line with the GMC guidance by providing Mr L with a clear and accurate explanation about why the diagnosis had not been recorded in the records. We have seen no indication the Practice did anything wrong in relation to the clarity of the information it presented him.
22. We hope our consideration of this issue gives Mr L some reassurance.
Consultations
23. Mr L complains a doctor at the Practice deliberately misled him by agreeing to write to dermatology during a consultation in May 2024 but did not.
24. GMC guidance states medical professionals must make sure records of their work are clear and accurate.
25. From his records for the May 2024 consultation, we can see Mr L attended the Practice and discussed his sick notes. We can see Mr L wanted to see a diagnosis added to his sick note. He also informed the doctor he would not receive or agree to any medical treatment.
26. A plan was also outlined in the records where the doctor ‘will talk to (his) usual GP and see what (they) can do for future sick notes’.
27. We recognise there is a disparity between how the doctor noted what the next steps would be in contacting Mr L’s usual GP, and Mr L’s recollection of the doctor saying he was going to contact dermatology.
28. We recognise Mr L is frustrated the Practice did not contact dermatology as he had understood it would. As an independent organisation we need to consider Mr L’s and the Practice’s recollections. In this case, we have conflicting evidence. We are unable to put more weight on his recollection or the Practice’s evidence. Upon consideration, this is not something we can reach a decision on even on the balance of probabilities. This is because of how contradictory the recollections are.
29. We understand Mr L will find this disappointing and we are very sorry about this.
30. Mr L also complains the same doctor, at a consultation in June 2024, showed Mr L on screen an old dermatology letter from May 2014, but presented it as a recent response following his May 2024 consultation.
31. GMC guidance states the exchange of information between the medical professional and the patient is central to good decision making. A medical professional must provide a patient with information they want or need in a way they can understand. This includes the potential benefits or risks of harm of treatment.
32. We can see from the records, in June 2024 the doctor confirmed he had spoken to Mr L’s usual GP. They agreed to make changes to his sick note to the specific dermatitis as described in the dermatology letter of May 2014.
33. In this consultation the doctor recorded they discussed whether Mr L would like to see dermatology again and Mr L did not want further treatment. The doctor also recorded they discussed the pros and cons of potential treatment and the possible positive impact of this on Mr L’s skin condition. The doctor confirmed the next steps with Mr L which included for Mr L to consider whether he would like the Practice to refer him to dermatology for review.
34. We again recognise there is a disparity between how the doctor recorded what happened and what Mr L’s recollection is.
35. As explained above, as an independent organisation we need to consider both parties’ version of events. In this case, we do not have objective evidence to consider which account of the events is more likely to than the other.
36. We recognise Mr L is frustrated and considers the doctor showed a previous dermatology letter and tried to present it as a recent response. However, we are unable to put more weight on either parties’ recollection. Upon consideration, this is not something we can reach a decision on even on the balance of probabilities. This is again because of how contradictory the recollections are.
37. We understand these consultations have caused Mr L some confusion and distress. Based on the evidence, we cannot reach a decision and are sorry for any disappointment this causes.
Practice response
38. Mr L complains the Practice responded to his complaint by lying to cover up the doctors’ mistakes and blaming administration/reception.
39. Mr L’s issues here relate to the circumstances where after his consultation in May 2024, he believed the doctor would write to dermatology and wanted a copy of this correspondence.
40. Our principles state organisations must be open and truthful when accounting for their decisions and actions.
41. When Mr L complained to the Practice, it responded to him explaining it had investigated the issue and it had listened to the telephone conversations on the relevant date.
42. In the Practice response, it states when Mr L enquired about the supposed letter at reception, a GP appointment was offered to him. Due to availability, an appointment was unavailable till the following week. Mr L declined the appointment as he wanted to see a specific doctor to get a copy of the letter.
43. The Practice says the reception staff explained the process of requesting correspondence and offered to see if she could find the letter he was referring to. When Mr L informed her of the date of the letter, he was told there was no letter in his records for that date.
44. Mr L says she said she could see an email from March 2014 but could not see the contents of this. (The Practice later confirmed, this was only a sick note that was sent to Mr L.) The reception staff then told Mr L she would send a message to the doctor to ask for a copy of the letter Mr L was referring to, to be sent to him.
45. Later the same day, Mr L says he spoke to another member of reception staff who confirmed the message was sent to the doctor but that it had not been reviewed yet.
46. Mr L asked when this would be actioned and was informed they could not give a timeframe. Mr L says she offered for the Practice to contact Mr L when the doctor had reviewed the message which Mr L declined. He said he would contact the Practice again the following day.
47. The next day Mr L spoke to the reception staff at the Practice and he said the receptionist neither confirmed nor denied if the doctor sent a letter to dermatology.
48. The Practice said if the staff member had looked at the message from the doctor, she would have seen the doctor had in fact responded and wanted Mr L to make an appointment with him.
49. Three days later, Mr L received a message from the Practice to make a follow up appointment with the doctor.
50. The Practice explained it did not provide Mr L with conflicting information. It said it was struggling to help him because the letter he was requesting a copy of (a letter from his doctor to dermatology after his May consultation) did not exist.
51. We understand this situation would have been extremely frustrating for Mr L. It appears there was a misunderstanding which was prolonged causing distress.
52. However, we have seen nothing to suggest the Practice lied in its response. The Practice did say if the receptionist looked at the record she could have seen the doctor’s response, but we do not consider the Practice blamed reception staff for the confusion.
53. We consider the explanation the Practice has provided is clear and honest as to why there was some confusion. The Practice has adhered to Our Principles as it has been open and truthful surrounding the decisions and actions it took. It also recognised there was some confusion which hampered its ability to help Mr L due to the correspondence he was requesting not existing.
54. We therefore consider there are no indications of failings.
55. We understand some of our consideration of Mr L’s complaint may be disappointing, which we are very sorry for as we cannot come to a decision based on the evidence. However, we hope our consideration of the other parts of his complaint provide him with some reassurance.
56. We thank Mr L for bringing his complaint to us.