Section 1Diagnosis delays
Coincidences can happen The outcome
A middle-aged woman with a family history of The MDU commissioned expert reports from a GP and a
coronary heart disease was seen by an out-of-hours cardiologist.
GP after developing chest pain. She complained of
central chest pain, moving to the left side which
The cardiologist felt that the GP’s initial diagnosis was
she described as like a knot. The on-call doctor
correct. Given the normal ECG, and given that the pain
recorded that the pain was not increased upon
was associated with chest wall tenderness, he expressed
exertion or with food. The patient’s blood pressure
real doubts as to whether the claimant had cardiac chest
was found to be 140/80. The doctor diagnosed
pains during the initial consultation. In addition, the
gastritis and prescribed Omeprazole.
patient did not mention chest pains during the
consultations with the other GPs in the practice in the
Two months later she saw a GP from her own practice as intervening period between the initial presentation and
an emergency patient complaining of chest pain that had the hospital admission.
started three days previously. On examination she
complained of tenderness in the centre and left of her
Both the GP and cardiologist experts agreed that the
chest. She was slightly short of breath and said that the
presenting symptoms would not have justified an
pain was worse on severe exertion and when taking
immediate referral. Even if the patient had been referred
deep breaths. She described the pain as constant.
for outpatient cardiological assessment, given likely
Examination revealed tenderness over the left upper
waiting times for referrals and routine investigations at
chest. No record was made of the patient’s blood pressure.
the local hospital during this period, it was unlikely she
would have had an angiogram before the event which
An ECG was normal and the GP diagnosed musculoskeletal led to her hospitalisation.
chest pain and gave advice on analgesia. The doctor
recorded advising the patient to return or contact the
As a result the MDU sent a letter of response to the
out-of-hours service if her symptoms changed or were
claimant’s solicitor denying liability. It made clear that
not settling.
experts agreed it was unlikely the chest pain their client
had on the day of the consultation with the GP was
The patient attended the surgery on a further six occasions cardiac, and, even if it was, it was most unlikely that
but did not complain of any further chest pain during investigations would have avoided emergency admission.
those visits.
Three months later, after receiving the MDU’s letter
Eight months later, the patient was taken to hospital by rebutting the claim, the claimant’s solicitor wrote stating
ambulance where she was diagnosed with acute coronary that she no longer wished to pursue the case.
syndrome and non Q wave myocardial infarction.
She underwent an angioplasty and stenting and made
a good recovery.
Two years later the GP from the patient’s own practice,
an MDU member, received a solicitor’s letter. The letter
claimed that the GP should have referred the patient for
urgent cardiological assessment. It was alleged that, had
a diagnosis been made earlier, the patient’s condition
could have been treated before it became acute and thus
“…experts agreed that the
she would have been spared the trauma and pain of
hospital admission. The patient was claiming a small sum
presenting symptoms would not
in damages for permanent damage to her heart and for
have justified an immediate referral.”
the pain and suffering which resulted from the delay in
diagnosis.
12
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