Section 1Diagnosis delays
Mystery abdominal pain
A man in his 30’s attended his GP complaining of The MDU obtained the opinion of a GP expert who
pain in the lower abdomen which had begun that advised that the notes showed that the member’s
morning. There was no associated nausea or assessment of the patient was ‘very thorough’ and
vomiting. The GP noted that she carried out a full included an appropriate physical assessment, including
examination of all areas of the patient’s abdomen, careful examination of all quadrants of the abdomen
first by superficial palpation and then by careful and noting that there was no rigidity or guarding.
deep palpation, including testing for rebound
tenderness. There was no rigidity or guarding,
The expert also commented that acute appendicitis is
although the GP noted that there was mild
often associated with a raised temperature and tachycardia,
tenderness in the hypogastrium.
neither of which had been present. He concluded that
given the full history obtained by the GP, and the
A rectal examination was unremarkable and the pulse absence of signs suggestive of appendicitis, diverticulitis
was normal at 80 beats per minute. There were no or peritonitis, her suggestion that the pain might be due
urinary problems. The patient was advised that the pain to constipation or an irritable bowel was perfectly
could be related to an irritable bowel, or constipation - reasonable. In his view, the GP had acted responsibly by
which the patient said he had experienced that morning. advising the patient to return if his condition worsened
The GP prescribed a laxative and advised the patient to and that surgery may well have been less complicated if
seek medical advice immediately if the symptoms worsened. the patient had returned earlier.
A week later the patient returned and was seen by a
different GP. The patient told this GP he was still in pain,
and also complained of night sweats, light-headedness
The outcome
and weakness. On examination the GP noted the
patient’s abdomen was tender in the right iliac fossa. In the light of this report, the MDU provided a detailed
The second GP suspected appendicitis and referred the response to the patient’s solicitors, denying the allegations
patient to hospital that day, the referral letter stated that made against the GP. This letter of response made it clear
the pain had been present for one week. The patient that a GP expert had advised that a reasonable body of
underwent an appendicectomy and a colostomy. The competent GPs would have managed the case in the
hospital records showed that the patient was eventually same way as our member had done. The MDU stated
diagnosed with acute diverticulitis that had perforated that the examination had been appropriate, including a
into his appendix. The colostomy was later reversed. test for rebound tenderness, and that it was improbable
A year later, the first GP, an MDU member, received a
that there were any signs of appendicitis at this time.
solicitor’s letter claiming that she had failed to carry The claim was eventually discontinued.
out a proper physical examination and as a result had
negligently missed a diagnosis of appendicitis. The letter
claimed that, had the correct diagnosis been made at
that stage, a simple appendicectomy could have been
performed laparoscopically and the colostomy avoided.
The patient was claiming damages for pain and
suffering, loss of earnings and the cost of care and
assistance. The member contacted the MDU for help.
“…the GP had acted responsibly by
advising the patient to return if his
condition worsened…”
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