SPSO Individual Decisions

Mrs C, who works for an advice agency, complained to us on behalf of Miss A. Miss A had attended her medical practice after falling over on her ankle. Her appointment was made by her pharmacist, who thought Miss A might have a deep vein thrombosis (DVT, a blood clot in the vein). Miss A was examined by a doctor, who diagnosed a calf strain. She was advised to take pain relief. However, Miss A's pain continued and she attended A&E on a number of occasions, where she was diagnosed with a fractured ankle. Miss A continued to report problems and was subsequently referred to a vascular surgeon (a surgeon who treats disorders of the circulatory system). A DVT was found and Miss A was required to have her leg amputated below the knee. Mrs C complained to us that the practice failed to appropriately diagnose and treat Miss A and about the way they dealt with Miss A's subsequent complaint. We took independent advice from a GP. They found that Miss A's diagnosis had not been unreasonable, that she had been appropriately examined and that her circulation was reasonably assessed. They also found that Miss A's complaint received a reasonable reply. We therefore did not uphold Mrs C's complaints. However, the adviser noted that Miss A's GP had not been alert to Miss A's early signs of PVD (peripheral vascular disease, or peripheral arterial disease (PAD)) which should have been followed up. We therefore made recommendations to address this.

Mr C complained about the care and treatment he received from the medical practice. In particular, he raised concerns about a specific consultation where he felt that he should have been referred to a psychiatrist due to him suffering from severe depression. He was not referred to psychiatry until around a year later and he considered this to have been to the detriment of his mental health in the interim period. He also complained that the practice had increased his dosage of antidepressant medication to what he considered to be an unsafe level. We obtained independent medical advice from a GP. They noted that details of the consultation in question had not been recorded and they were, therefore, unable to assess whether a referral to psychiatry was indicated at that time. While they did not consider that there was any indication for a referral at subsequent consultations six and eight months later, due to the fluctuating nature of Mr C's mental health difficulties we could not conclude that the same applied at the time of the relevant consultation. With regard to Mr C's medication, the adviser noted that it was prescribed at dosages within recommended levels and they could find no evidence of unsafe prescribing. In light of the identified record-keeping failure, we were unable to evidence that Mr C had been appropriately assessed and, in turn, whether the decision not to refer him to psychiatry was reasonable. Therefore, on balance, we upheld the complaint and made some recommendations to the practice relating to record-keeping.

Mrs C complained about care she received from the medical practice when she attended with an injury to her toe. Mrs C has diabetes which makes foot complications more common and harder to treat. Mrs C had been prescribed an antibiotic to treat the infection but she had returned to the practice around a month later as she was still in pain, at which point she was referred to hospital. She had to have emergency surgery, resulting in the amputation of her big toe. Mrs C said that she had attended the practice three times before being referred to hospital and that the amputation could have been avoided if the practice had provided appropriate care and treatment when she had first attended. The practice said that they had conducted an audit and could not find any evidence that she had attended on the first occasion. We took independent advice from a GP adviser. The adviser considered the records available and found the treatment Mrs C was given was appropriate, and that Mrs C's GP could not have foreseen that Mrs C's condition deteriorated or recurred between the point at which she was prescribed antibiotics and being referred to hospital. We also found no evidence of the initial appointment that Mrs C referred to. We did not uphold Mrs C's complaint. Related reading View Decision Report 201507543 as a PDF (11.18 KB) Updated: March 13, 2018

Miss C complained that doctors at her GP practice had failed to refer her for appropriate tests in order to diagnose a tumour in her bowel. After taking independent advice on this case from a GP adviser, we did not uphold Miss C's complaint. The advice we received was that the appropriate guidance had been followed and that there had been no delay in referring Miss C for further investigations. Related reading View Decision Report 201508029 as a PDF (10.78 KB) Updated: March 13, 2018

Mrs C, who is an advice worker, complained to the practice about a lack of urgency in acting on Ms A's concerns about a problem with her young daughter's hip. She said that Ms A reported that her daughter's left leg was longer than her right leg and that one of the GPs failed to thoroughly examine her daughter. In addition, it was only after Ms A continued to report her concerns that her daughter was referred to hospital. However, one of the GPs marked the referral as non-urgent and Ms A had to ask the practice again to make an urgent referral. Her daughter was diagnosed as having a dislocated hip. The practice apologised for the delay and said they had learned from the complaint. They were now aware that they can directly ask for an ultrasound scan of the hip in such circumstances. The GPs were more aware of the signs to look for and would mark any referrals as urgent. The practice apologised for the distress which was caused. We took independent advice from a medical adviser who noted that the response from the practice to Ms A's complaint was thorough and explained the shortcomings which they had identified. The practice said that their GPs were now more aware of the referral options, the need for urgency and the later signs of congenital dislocation of the hip. However, we identified further failings by one of the GPs in regards to the inadequate examination and recording of findings related to Ms A's daughter and a failure to stress the urgency of the situation in the hospital referral letter, so we upheld the complaint.

Mrs C complained that the practice cancelled an important appointment with the practice nurse without giving her notice. Mrs C moved to a different practice, and she complained there was delay in sending her medical records to the new practice. We found that the practice could have told Mrs C sooner that the appointment had been cancelled, and there was no record that they had tried to contact her before she arrived for the appointment. We also found that the practice should have tried to re-arrange the appointment for Mrs C, or arrange an alternative appointment nearby. In addition, we found that there was an unexplained delay of several weeks in the practice sending Mrs C's medical records to her new practice. We upheld Mrs C's complaints. Shortly after Mrs C complained to the practice, it changed management from GPs to the local health board, as the GPs had left the area. Given these specific circumstances, we did not make recommendations to the health board, as they were not responsible for running the practice at the time of the events complained about. However, we asked the board to confirm whether any relevant staff currently working at the practice were there at the time of the events complained about and, if so, to share our findings with them so they could learn lessons from what happened, to try to ensure that similar problems do not arise again. Related reading View Decision Report 201502517 as a PDF (11.24 KB) Updated: March 13, 2018

Miss C was examined by her current GP and had a contraceptive coil removed. However, at that time, Miss C had thought that all coils had already been removed; therefore, she thought her previous GP had failed to remove a coil. We looked at the file on Miss C's complaint, at her medical records from her current and previous GPs, and we took independent advice from a GP adviser. We noted the adviser's comments that patients should be aware if they have a coil in place and if it needs to be removed, and that it is a patient's responsibility to tell their GP if they wish to have an existing coil removed. We found that the care provided by Miss C's previous GP in relation to fitting and removing coils was reasonable in the circumstances at the time. Therefore, we did not uphold Miss C's complaint. Related reading View Decision Report 201501740 as a PDF (11 KB) Updated: March 13, 2018

Mrs C said that she had moved to a new GP surgery, where her symptoms had been quickly diagnosed as due to hyperthyroidism (excess thyroid hormone). Mrs C then complained to her former GP practice that she had reported the same symptoms to them for the past two years but they had failed to reach the true diagnosis. She complained that she may have been prescribed inappropriate medication. The practice maintained that they had provided appropriate treatment based on the symptoms reported at the time. They apologised for the failure to order a set of blood tests on one occasion and said this was caused by an administrative failure. They said that it was not possible to say that hyperthyroidism was present at that time. We sought independent advice from a GP adviser. The adviser considered that, other than the failure to carry out specific blood tests on one occasion, the practice had performed appropriate investigations in an effort to reach a diagnosis. The symptoms which Mrs C had shown during the period were not classically suggestive of hyperthyroidism. The adviser did not think it was a failure that the GPs at the practice were not alerted to a possible alternative diagnosis. We did not uphold the complaint. Related reading View Decision Report 201502050 as a PDF (11.18 KB) Updated: March 13, 2018

Mrs C's father (Mr A) visited the practice on several occasions with stomach problems. Although an endoscopy (an investigation of the stomach using a camera) was considered early on, Mr A was instead treated for stress and anxiety for about six months, before an endoscopy was arranged. The endoscopy led to a diagnosis of stomach cancer. Mrs C raised concerns that Mr A was not referred for an endoscopy sooner, and referred to an online article that recommended urgent referral for patients over 55 with unexplained and persistent dyspepsia (indigestion). After taking independent medical advice from a GP adviser, we did not uphold Mrs C's complaints. Our adviser considered the GP's actions were consistent with the national guidance on dyspepsia, and reasonable in light of the information known at the time. Our adviser said that Mr A's dyspepsia was not unexplained, as he had been diagnosed with stress (and there were several factors that supported this diagnosis, including that Mr A's symptoms seemed to respond to medication for this). Our adviser also noted that the GP had appropriately checked for any 'alarm features' and regularly checked Mr A's blood tests. When Mr A's blood test showed an abnormality, he was appropriately referred for an endoscopy. Related reading View Decision Report 201406016 as a PDF (11.24 KB) Updated: March 13, 2018

After Ms C was diagnosed with Lyme Disease (an infection transmitted by the bite of ticks) in 2014, she complained that her GP practice had failed to identify the symptoms of the condition at a consultation a year earlier. Ms C said that in 2013 she presented with a tick bite and large surrounding rash on her arm but the doctor she saw on that occasion did not offer her blood tests or antibiotics. Ms C was concerned that an electronic record of the consultation differed to the hand written entry by that doctor in her medical records and that a second doctor did not put accurate information in a referral letter to an infectious diseases specialist. Ms C also complained that a health care assistant was unprofessional with matters related to her blood test in 2014. We took independent advice from one of our medical advisers who is a GP, and found that there was no evidence to indicate that Ms C had a bite mark on her arm or that the rash was typical of that associated with Lyme Disease. We considered, on balance, that the first doctor's assessment, diagnosis and suggested treatment were reasonable at the time. We also found that the electronic medical record did not differ materially from the handwritten record. Furthermore, the referral letter to the infectious disease specialist was consistent with the recorded entries in the medical records and were not inaccurate or misleading. We concluded that it was good practice that the health care assistant had sought advice from a senior colleague regarding the blood test and took steps to appraise himself of the laboratory guidance. Whilst it was difficult for us to comment on the discussions between Ms C and the health care assistant, we obtained electronic records which provided an audit of the likely advice that Ms C was given by him during a phone conversation about the blood results. We, therefore, did not uphold the complaints. Related reading View Decision Report 201405101 as a PDF (11.53 KB) Updated: March 13

Mrs C complained about the care her late daughter (Miss C) received from her former GP practice between January and August 2011 after Miss C was diagnosed with a brain tumour in July 2012. Mrs C was concerned that Miss C was misdiagnosed with depression and, given that her symptoms (headaches, dizziness, tiredness and dilating pupils) were getting progressively worse, she should have been referred for a brain scan. Mrs C also provided evidence to show that Miss C had been unwell at college and had attended another medical facility. We took independent advice from one of our medical advisers who is a GP. Based on their advice, we found that the initial diagnosis of vertigo was reasonable based on the symptoms of dizziness and abnormal eye movements. It was also noted that Miss C had described symptoms of anxiety which were explored by the practice, and the reasons for this were plausible. We did not find evidence in any of the records made of the eleven GP consultations, the records made by the college, or medical facility, that Miss C had reported suffering from headaches or that her condition was getting progressively worse. We found that Miss C's symptoms were not consistent with the symptoms of brain tumour set out in the relevant Scottish guidelines for referring patients for urgent assessment (such as for a brain scan). We concluded that this was a tragic case where Miss C's symptoms were not clearly typical of a brain tumour. Related reading View Decision Report 201403274 as a PDF (11.32 KB) Updated: March 13, 2018

Mrs C complained about the treatment she had received from her GP when she reported a lump in her breast. Mrs C attended the medical practice twice before being referred to the breast clinic where she was later diagnosed with breast cancer. Mrs C said that she should have been referred to the breast clinic sooner and was concerned about the GP's attitude. Mrs C also said that when she was referred, the referral should have been classed as urgent rather than routine. During our investigation we asked for independent advice from one of our GP advisers. Our adviser found that the GP had conducted a thorough examination of Mrs C and gave her appropriate advice regarding monitoring the lump. The adviser said that it was hard to judge the attitude of the GP through the medical notes, however, based on the record of Mrs C's condition at the time of the referral, and relevant National Institute for Health and Care Excellence (NICE) guidance, a routine referral was appropriate. We did not uphold Mrs C's complaints. Related reading View Decision Report 201404053 as a PDF (11.09 KB) Updated: March 13, 2018

Mrs C, an advocacy worker, complained on behalf of her client (Mr A). She said that Mr A's medical practice had not passed on information to him that the hospital had given to them about a change in his treatment plan. We sought independent advice on this from one of our medical advisers, who said that it was the hospital's responsibility to pass this on, unless the hospital or patient asked the practice for information. We also noted from Mr A's medical records that a particular letter from the hospital to the practice would have led the practice to believe that the hospital had made Mr A aware of the change. The practice had also written in Mr A's medical records that they were having difficulties dealing with his family, and that they were trying to resolve the situation but so far this had not been successful. In the meantime, a locum doctor would normally see Mr A and his family at the practice or at the hospital, although the GPs at the practice would see them if there was an emergency. Mrs C complained that the practice had not told the family that they considered there were difficulties and that, if the family had known earlier, they would have changed to another medical practice. The evidence in Mr A's medical records, however, showed that the practice were proactively and constructively trying to address and repair the relationship problem, and our adviser saw no reason why they should have passed on the information in the records. We also noted that, although it would have been open to the practice to warn the family that if the situation did not improve they would be removed from the list of patients, the practice did not do this but were appropriately trying to resolve matters, which was good practice. Mrs C also complained about a point in relation to the practice's handling of her complaint, but we could not establish the facts about this. We did not uphold any of Mrs C's complaints. Related reading View Decision Report 201304600 as a PDF (11.

Mrs C has a complex medical history. She told us that because she had been experiencing extreme pain in her feet (to the extent that she could not walk) she needed to contact her medical practice on a number of occasions. She complained about a lack of support from the GPs at the practice. In particular, she said that, despite telling a GP that tramadol (a drug used to treat moderate to moderately severe pain) did not work for her, he continued to prescribe it. Another GP refused her a dosette box (a pill organiser that helps people on multiple medications to take these at the right time) and prescribed an anti-inflammatory gel, which she said the pain clinic she had previously attended had told her not to use. Mrs C said that both GPs left her without support and in great pain. We obtained independent advice from one of our medical advisers, who is a GP. After taking all the relevant information into account, including the complaints correspondence and Mrs C's medical records, we did not uphold Mrs C's complaints. We found that she was previously prescribed tramadol for chronic pain, and the new, acute pain she was experiencing had a different cause. Our adviser said that this pain might respond differently to tramadol, so the prescription was not unreasonable. Similarly, an anti-inflammatory gel could be used safely where anti-inflammatory tablets could not. Although Mrs C wanted a dosette box, we found that she did not qualify for this under the health board's criteria. Related reading View Decision Report 201304348 as a PDF (11.37 KB) Updated: March 13, 2018

Mr C had taken his late wife (Mrs C) to her medical practice as she had suffered from vomiting, diarrhoea and dizziness for two days, following a surgical procedure. Mrs C had a history of systemic lupus erythematosus (an inflammatory, multi-system autoimmune disease) and Mr C was concerned that due to his wife's medical history she should have been admitted to hospital. The GP who assessed Mrs C had diagnosed possible infective gastroenteritis, recommended medication and fluids and to seek a further medical review if there was no improvement. Mrs C deteriorated overnight and was admitted to hospital the next day where she continued to deteriorate and died a few days later. Mr C was concerned that his wife might have had a better chance had she been admitted earlier, and complained that the GP had not assessed her properly and had failed to arrange a hospital admission for her. As part of our investigation, we took independent advice from one of our medical advisers. After studying Mrs C's medical records, our adviser concluded that this was a tragic case of a rapid deterioration in a person with an extremely rare condition, and she did not see any evidence in Mrs C's records to suggest that the GP could have foreseen or prevented this. We did not uphold the complaint, as our adviser said that the GP provided appropriate clinical treatment and had no concerns about their actions. Related reading View Decision Report 201302500 as a PDF (11.32 KB) Updated: March 13, 2018

An MP (Mr C) complained on behalf of Ms A's family about the treatment Ms A had received from her GP practice. In 2008, Ms A had a mole removed from her scalp. Due to its location, the mole could only be partially removed, but tests found no signs of cancer. In May 2009, she went back to the practice having found a lump behind her ear. Blood tests initially suggested inflammation and possible glandular fever, but when further lumps appeared and did not go away, the practice arranged for a referral to a haematologist (a specialist in blood-related disorders). Tests led to a diagnosis of skin cancer, linked to the scalp mole. Ms A had further surgery on the mole and to remove a number of lumps from her neck in February 2010 . Shortly after this, Ms A told the practice that she had a new lump in her back. She asked for a GP home visit but this was declined and instead a review was proposed after a week. She was unhappy with the lack of urgency shown by the practice and transferred to a different practice. Ms A later developed a breast lump which became malignant. Despite treatment, she died in January 2012. Mr C complained that the first practice did not recognise the severity of Ms A's condition or treat her with the required level of urgency. After taking independent advice from one of our medical advisers, we were satisfied that there was no evidence of cancer in 2008. There was no cause for the practice to arrange any further investigations at that point, and Ms A was appropriately advised to monitor the mole herself and contact the practice should she have any concerns. When the lumps appeared in her neck, blood tests were arranged and an appropriate referral was made to haematology for a biopsy (tissue sample) to be taken. With regard to the lump in her back, we found the practice's approach to have been reasonable, as Ms A was already under the care of cancer specialists, and had an appointment arranged. We accepted advice that the delay of one we

Mr C had a history of heart problems and was previously a patient of the practice. He said that, while he was their patient, they twice lost blood samples although the explanation given was that they were lost by the hospital. Mr C also complained that on one occasion when he attended the practice while experiencing heart symptoms, he was seen by a nurse and then sent home after discussing his condition with a doctor, having been told he might have shingles. He said that when he returned home, he was so ill that he required an emergency ambulance to take him to hospital. To investigate the complaint, we obtained independent advice from one of our medical advisers, and took this into account with all the available information, including the complaint correspondence and relevant clinical records. We upheld the complaint, as our adviser identified a number of problems in handling Mr C's blood samples. They also said that when Mr C went to the practice he appeared to be suffering from a number of symptoms indicating the likelihood of a heart attack, which should have been addressed differently. In accordance with relevant guidance he should have received a detailed assessment by a doctor and been treated with glyceryl trinitrate spray to relieve pain.

Ms C visited her medical practice, complaining of pain in her lower abdomen, and was referred for an ultrasound scan (a scan that uses sound waves to create images of organs and structures inside the body). When she contacted the practice for the results she was told that her GP had noted that no further action was required. A few months later, the health board contacted Ms C asking her to come back for a further scan. She initially cancelled this appointment because she had been told no further action was required. However, the hospital told her that another consultant had reviewed the first scan and thought it appropriate that she should attend for a follow up. The follow-up scan showed that cysts, which had been identified on the previous scan, had enlarged. Ms C was unaware that cysts had appeared on the original scan and complained to the practice that she was not told about this. She remained dissatisfied with the practice response. We found that the original ultrasound scan was reviewed by two consultants and their opinion had been divided as to whether there was a need for a follow-up scan. We also found that the practice had not told Ms C about the cysts as they were an incidental finding, and not thought to be responsible for Ms C's abdominal pain.

Mrs C was unhappy with care and treatment she had received from a doctor at the medical practice, and had tried to avoid consulting him. However, she had to see him for a medication review. She was unhappy about this and raised concerns about the treatment she received from him when she attended the review. In particular, she complained that he changed her medication. To investigate the complaint, we took independent advice from a medical adviser. Their advice was that it was entirely appropriate for the practice to have made arrangements to review Mrs C's medication, and that the decision to change her medication was reasonable. We, therefore, did not uphold this complaint. We noted that the practice said that they had asked Mrs C to attend for review several times before an appointment was eventually arranged, but Mrs C said she did not receive such requests. As the practice had not kept records of the requests, we made a recommendation about this. Mrs C also complained about a further consultation with the doctor when she was taken ill and had to arrange an urgent appointment. She said the doctor failed to examine her, instead passing her on to the practice nurse, and that he had panicked her by discussing the possibility of norovirus (winter vomiting virus). The doctor said that he did examine Mrs C, with the assistance of the practice nurse, and that he diagnosed a chest infection and made arrangements to have her admitted to hospital. Mrs C disputed this, maintaining that she was not examined and that a chest infection was not mentioned. The advice we received was that the records suggested an appropriately managed chest infection. This did not accord with Mrs C's account of events but we were unable to reconcile this account with the documentary evidence and we did not uphold her complaint.

Miss C complained that, when she visited her GP as a new patient, he refused to prescribe her Zopiclone (a drug used to treat sleeping problems). She said she had been unable to sleep because she had been in a hypomanic stage (a period of mild over-active, excited behaviour) of her bipolar disorder (a condition that affects a person's mood) for the last two months. From previous use, she said she knew that Zopiclone would help. She told the GP that her former GP and her psychiatrist found this acceptable. Our investigation found that the GP had been right to be cautious as Zopiclone is a drug that must be prescribed with care. For example, it is a drug that is open to abuse as a so-called street drug. Also, Miss C's medical records had not yet arrived, so the GP's knowledge of her was very limited. He did prescribe alternative medication, so there is no question that she was given nothing to help with her condition. The GP then contacted her former GP and her psychiatrist and, having been reassured by some of the information from them, prescribed the Zopiclone the next day. Our independent medical adviser considered that this was a very reasonable approach and we did not uphold Miss C's complaint. Related reading View Decision Report 201004490 as a PDF (11.3 KB) Updated: March 13, 2018

Mr C complained to us about the treatment he received from his medical practice for problems with his neck. GPs at the practice saw Mr C five times during a five month period. He had reported a number of symptoms, including neck pain. Mr C reported that at one appointment he specifically raised concerns about cancer, but there was no record of this conversation in his medical file. He also reported being able to feel a lump, but none of the GPs who examined him during this period were able to find this until his final appointment. He was then referred for an urgent ultrasound scan (a special scanning technique that uses sound waves to produce internal images of the body), which found a lump that turned out to be cancerous. Mr C had a history of unexplained deep vein thrombosis (blood clots) dating back two to three years. He was concerned that this put him at increased risk of developing cancer, but that his GPs had not taken this into account. In our investigation we examined Mr C's medical records and evidence from Mr C. We also took independent advice from one of our medical advisers. Our investigation found that, while there was conflicting information about one consultation, no evidence of a neck lump was found before the final consultation. While the GPs should have taken Mr C's history of unexplained deep vein thrombosis into consideration in making a diagnosis, without any evidence of a lump there was no evidence to act on. We also found that the practice had clearly set out the issues that were discussed at each consultation over the five month period, and had passed on an apology from one of the GPs involved. Related reading View Decision Report 201202544 as a PDF (11.48 KB) Updated: March 13, 2018

Mr C was discharged from hospital after having major surgery to remove tumours from his stomach area. When the district nurse attended she noted that the wound, which was substantial, had reopened. She called the medical practice to request an ambulance. The GP was visiting patients at the time and could not be located. Mr C's wife said that if the GP could not be located within five minutes she would call the ambulance, which she did. By this time the GP was on his way to Mr C's house but, when he was advised that an ambulance had been called, he returned to the surgery. Mr C complained that the practice did not immediately call for an ambulance. We took independent advice from one of our medical advisers, who explained that it was reasonable for the GP to wish to assess Mr C before deciding whether an ambulance was necessary. He commented that in this case it was probably necessary, but that it might not have been necessary to call an emergency ambulance. He also pointed out that the district nurse would know that she could call an ambulance directly by phoning 999 if this was required. As our investigation found that the practice acted reasonably, and as we noted that the ambulance would not have arrived any more quickly had the GP reviewed Mr C first, we did not uphold this complaint. Related reading View Decision Report 201202585 as a PDF (11.31 KB) Updated: March 13, 2018

Mr C complained that a medical practice would not issue prescriptions that he considered were appropriate to accommodate his individual circumstances. Mr C wished, as standard, to receive 56 day prescriptions (not the 28 day prescriptions the practice issued to him), for a long standing medical condition. Mr C had only recently moved to the practice. He also complained that the practice did not deal with his complaint appropriately. We took independent advice from our medical adviser. After careful consideration of the advice and taking into account that the practice had made Mr C a reasonable offer to try to suit his personal circumstances, we did not uphold the complaint. We also considered that the practice had appropriately addressed Mr C’s complaint in good time. They had not, however, advised him of his right to bring his complaint to us if he wished to do so, which they are required to do. We upheld this aspect of his complaint.

Mrs C attended the medical practice with her son (Master A), who was complaining of a high temperature, sore throat and sore ear. A GP diagnosed a virus, however, his condition worsened over the next few days and they returned to the practice. During this visit, another GP diagnosed Master A with an ear infection and prescribed antibiotics. The following week, Mrs C and her son returned to the practice and were referred to a hospital for treatment. A doctor at the hospital diagnosed Master A with an abscess and carried out an ear procedure. The following week, Mrs C returned Master A to the practice as he had pain behind his ear. The GP prescribed more antibiotics, but several days later Mrs C took her son returned as the area behind his ear had worsened. The GP cut the lump to drain it. Mrs C said this was done without any anaesthetic and was painful. Master A's condition failed to improve and when they returned to the practice 11 days later, a GP diagnosed an infection of one of the bones in the ear and advised them to return to the hospital to see another specialist. However, Mrs C took her son to another country for treatment. She said that he was then diagnosed with inflammation of the lymph node and received appropriate care there, and that the condition cleared within two weeks. Mrs C complained that the practice failed to diagnose the problem accurately. She also said that the ear infection would not have become so severe if the GP at the first consultation had prescribed antibiotics, and that they had failed to take her concerns seriously or to document the consultation. We did not, however, uphold Mrs C's complaints. After taking independent advice from our medical adviser, we found that the practice's treatment, decisions and management were reasonable, including that the GP did not use a local anaesthetic when cutting the abscess. This is because an anaesthetic can spread the infection to surrounding tissue. We also found no evidence that the GP failed t

Mr C complained about the care and treatment that his late wife (Mrs A) received from her medical practice from early 2010 when she went there complaining of irregular bleeding. He said that it was not until mid-2011 that a diagnosis of endometrial cancer (cancer in the lining of the womb) was confirmed. He said that his late wife's care and treatment had been inadequate and that the relevant guidelines were not followed. In investigating Mr C's complaint we carefully considered all the relevant information, including the practice’s complaint’s file and Mrs A’s clinical notes. We also obtained independent advice from our medical adviser. The adviser said that this type of illness usually presented after the menopause and was usually benign (not cancerous). However, Mrs A’s case was unusual as it did not fit this pattern and the symptoms of irregular bleeding with which Mrs A presented appeared to indicate that she was starting the menopause. The adviser said that in the circumstances this was not an unreasonable view to take, and that throughout 2010 and early 2011, investigations appeared to bear this out. It was not until after Mrs A had reported that her symptoms were ongoing and was referred to a gynaecologist, that tests confirmed, in June 2011, that Mrs A had endometrial cancer. Her condition deteriorated rapidly and she died in October 2011. Having taken this advice, we found that Mrs A’s care and treatment had been good, and well within the limits of acceptability. We also found that there had been no delays on the part of the practice and they had followed all relevant national guidance. Related reading View Decision Report 201200357 as a PDF (11.47 KB) Updated: March 13, 2018