SPSO Individual Decisions

Ms C complained about the length of time that it took to provide a diagnosis for her father (Mr A), who was eventually diagnosed with pancreatic cancer. Mr A initially attended his medical practice complaining of abdominal pain, weight loss and vomiting. He was prescribed medication, blood samples were taken, and he was referred for an endoscopy (a medical procedure where a tube-like instrument is put into the body to look inside). This found a hiatus hernia (where part of the stomach pushes up into the lower chest) and gastritis (inflammation of the lining of the stomach), for which Mr A had already been given medication. The blood tests, however, showed abnormalities, and Mr A's GP remained concerned. She referred Mr A for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body). This came back normal, but the head of Mr A's pancreas was not visible. The GP remained concerned, so she referred Mr A for an urgent CT scan (a special scan using a computer to produce an image of the body) through an urgent suspected upper gastro-intestinal cancer pathway (a route into further treatments not available to GPs directly). We took independent advice from our medical adviser, which indicated that the steps taken by the GP in reaching a diagnosis were appropriate. The adviser noted that pancreatic cancer is difficult to diagnose. The diagnostic path required several tests, but there was no evidence of any delays within the practice in either making referrals or passing on test results. Our investigation also found no evidence of delays in providing test results. Related reading View Decision Report 201202678 as a PDF (11.53 KB) Updated: March 13, 2018

Miss C complained that GPs failed to carry out appropriate investigations into the symptoms her late mother (Mrs A) was presenting with from November 2010. Mrs A was diagnosed with lung cancer in May 2011 and died in August 2011. Before she was diagnosed, Mrs A had been treated and monitored for breathlessness which was not resolving with the treatment provided. The family told us that they felt that the GPs were treating Mrs A as if her symptoms were psychological and that as a result there was a delay in diagnosing the cancer. When Mrs A (who was a smoker) first complained of breathlessness, various tests were carried out. Her chest x-ray and blood tests were reported as being normal. Mrs A continued to suffer breathlessness, however, and was reviewed regularly in the practice by the nurse. She was also seen by GPs and the out-of-hours service. In March 2011 Mrs A was diagnosed with a chest infection and prescribed antibiotics (drugs to treat bacterial infection). When the condition persisted, she was referred for a further chest x-ray. This x-ray was reported as abnormal and Mrs A was referred urgently for a CT scan (a special scan which uses a computer to produce an image of the body), after which she was diagnosed with lung cancer. Our investigation, which included taking independent advice from a medical adviser, found that the care and treatment provided to Mrs A was reasonable, and in line with the national and local guidance on investigating, managing and treating lung cancer. Although Mrs A had been referred for counselling from the community psychiatric nurse, we found no evidence that the GPs considered Mrs A's symptoms were psychological. The adviser said that the GPs clearly took note of Mrs A's physical symptoms and investigated them in a reasonable and timely manner, and in line with national guidance. Related reading View Decision Report 201200987 as a PDF (11.58 KB) Updated: March 13, 2018

Mr and Mrs C complained that the medical practice inappropriately prescribed their father (Mr A) anti-inflammatory medication on a long-term basis, without also prescribing gastric protection medication. Mr A had sciatica (lower back pain caused by pressure on a nerve) and osteoarthritis (the most common form of arthritis, affecting the joints) in his knees. He had been on a non-steroidal anti-inflammatory drug (NSAID) for a number of years when he attended hospital several times complaining of abdominal (stomach) pain. He was eventually admitted to hospital, where he was found to have a massive gastro-intestinal haemorrhage (severe bleeding in the stomach/intestine) because of a bleeding ulcer. Doctors were unable to control this, and although Mr A had emergency surgery, he did not survive. Our investigation found that guidance in 2008 said that gastric protection medication should be prescribed with NSAIDs. We upheld the complaints, as we found that from 2008 onwards Mr A should not have been prescribed a NSAID without this protection. We noted that this was in fact picked up at a medication review that year, which noted that Mr A was over 65 and a smoker and was, therefore, at increased risk of stomach bleed. The review said that if the NSAID prescription was continued, gastric protection medication should be added. The NSAID was then removed from Mr A's repeat prescriptions. However, a year later, a NSAID was added to his repeat prescriptions without gastric protection medication. The practice apologised to Mr C for this after Mr A's death and carried out a significant event analysis. Mr C also complained that the practice failed to diagnose and treat Mr A's ulcer. Mr A had attended the hospital with abdominal pain several times, and they had told the practice about this. We found that the practice were not required to follow this up unless the hospital specifically asked them to do so, and there was no evidence that Mr A attended the practice with a

Mr C had a history of mental health problems. In 2011 he started to become increasingly anxious with strong violent urges. He was able to control the urges but found it difficult and was concerned that he might harm friends or family members if he did not receive effective treatment. Mr C complained that his medical practice did not do enough to progress his treatment. He was unhappy with how they managed his condition, saying that they adopted a 'wait and see' approach. The medical records showed that therapists and the practice had made a number of referrals. We were satisfied that there was a pattern of reasonable care, and that the referrals made were detailed and appropriate and responsive to Mr C's circumstances. Mr C had also asked the medical practice to prescribe medication to help with his unwanted thoughts, but this was refused. Our medical adviser considered Mr C's case and said that medication should not be used to treat personality disorders. We, therefore, found that the decision not to prescribe medication was appropriate, as Mr C had been diagnosed with a personality disorder rather than a psychiatric disorder. Mr C is receiving ongoing treatment from a psychologist and we considered this to be the appropriate treatment for his condition. Related reading View Decision Report 201103386 as a PDF (11.36 KB) Updated: March 13, 2018