Section 1Diagnosis delays
Telescoping symptoms
A businessman visited his doctor in December whether he had drawn the doctor’s attention to the
1996 complaining of lumbar back pain, thought to specific question of weight gain. He responded that the
be right-sided sciatica, from which he had weight gain was a consistent thing, but he could not
suffered for 20 years. remember whether he had specifically mentioned it to
The GP arranged a referral to a physiotherapist. During
his doctors.
the consultation he also checked the patient’s blood Central to the dispute was the meaning of the entry
pressure and, following discussion, arrangements were ‘Wt ↓ 1 stone’ in the clinical notes. In a supplementary
made for the patient to attend the practice nurse in statement, the patient said he could not remember
January 1997 for a blood test to measure his cholesterol telling the GP that he had lost a stone but that he had
level. been advised to lose a stone. However, the patient
In February 1997 the patient was advised that his
modified his position before being cross-examined
cholesterol level was high. In light of a family history of
stating instead that the GP had told him to lose weight.
heart disease, the GP prescribed a course of statins and
He could not remember a specific figure.
arranged for another cholesterol test in one month. The In his original witness statement the GP had no specific
GP made a written note of the consultation which recollection of the consultations over a decade before.
included the observation ‘Wt↓1 stone’. However from his notes he said it was clear that the
There was no record of any further consultation, and
patient was on a low fat diet and had lost a stone in
shortly afterwards the patient moved to another area
weight. He said: ‘It is clear from this note that (the
and registered with a new GP.
patient) reported that he had lost a stone in weight…
If I had advised him to lose a stone in weight I would
Some years later the patient was diagnosed with have recorded this in the note. For instance I would have
hypothyroidism, and in the spring of 2006 he began written, ‘Advised to lose weight’, or ‘Advised ↓ weight’.
proceedings against the GP he had seen in 1996. I would not in any event have advised (the patient) to
He alleged this doctor had been negligent in failing to lose a particular amount of weight… as it would not
make the diagnosis in that year. Later he amended his have been my place to do so.’
allegations to failure to consider the diagnosis of
hypothyroidism by not inquiring directly about the
Both GP expert witnesses agreed that, had the GP been
relevant symptoms and signs of hypothyroidism.
told by the patient that he had lost a stone, he would
not have been negligent not to have investigated a
The patient claimed that he had been generally healthy possible diagnosis of hypothyroidism. Two consultant
and a keen sportsman until his 30’s, but that in 1995 he endocrinologist experts agreed that the claimant was
had begun to feel more ‘lethargic’ and not able to do as ‘most unlikely’ to have been hypothyroid in 1997 if he
much as he had previously, something that he attributed had lost a stone in weight.
at the time to the stresses of running a business. He
claimed that his condition would have been diagnosed
In summing up, the judge said he felt that the claimant
earlier had the GP arranged for him to undergo a
had ‘telescoped’ his symptoms back to the period in
thyroid function test after his fasting cholesterol level
1995 prior to his consultation with his GP. It was
was found to be high.
significant that there was no mention in any of the
notes prior to 1998, by any of the doctors who had seen
the patient, of a possibility of hypothyroidism or any
symptoms the claimant was now stating that he had
The outcome
been suffering from since 1995. In his Judgment he
referred to the opinion of the claimant’s expert
The case went to the High Court where the GP was
endocrinologist ‘who agreed that in his experience
represented by the MDU. In court, the GP agreed that
there was a tendency for those suffering from thyroid
he had not inquired into a possible diagnosis of
disease to tend to blame all their problems in their life
hypothyroidism because the claimant had informed him
on their disease’.
during the February consultation that he had lost a
Finding that the GP was not negligent, the judge ruled
stone in weight on a low fat diet. Had he not been told
that the patient was not suffering from hypothyroidism
about these changes he agreed he would have enquired
at the time of the February 1997 consultation.
further about the patient’s symptoms in order to
He concluded that the patient was looking back more
consider a possible diagnosis of hypothyroidism. He also
than a decade, that his memory was to some extent
accepted that he would have considered doing tests
‘playing tricks’ about when symptoms arose, and that
such as LFTs and blood glucose to establish other
his hypothyroidism most likely developed after 1997 by
possible causes of the elevated cholesterol.
which time he had changed GPs.
The patient claimed that his weight had started
increasing from 1995 and in his original witness statement
he said he was unable to lose weight and seemed to be
continually on diets and exercise. In court, he was asked
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