cASe fileS
More than a
headache
Hearing about others’
experiences can provide the
inside track on how to perfect
M
o
your practice. in this case a
.
c
t
o
o
H
p
different approach could have
K
c
t
o
i
s
resulted in another outcome
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e
s
i
d
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iss H was 25, had didn’t manage to sleep. management was reasonable the hospital, with a small
hardly ever been to she wasn’t feeling any for a short history of contribution from Mps
her gp and was not better by early evening, so headache in a previously on behalf of the gps.
taking any medication. she she went to her local a&e healthy young woman.
was a keen salsa dancer and department. she explained dr s did not suspect a
lived in a flat with two friends. to dr W, a junior doctor, subarachnoid haemorrhage learning points
Miss H had just started that she’d already seen two and Miss H did not mention
working as a qualified different gps, but still had a that her headache was ■ subarachnoid
accountant. one afternoon, headache. dr W decided to of sudden onset. haemorrhage crops up
she left work early and went see how Miss H progressed they were also supportive frequently in Mps case
to her gp practice because after more paracetamol of dr a, as his assessment files. although it is rare,
of a severe headache. she and an anti-emetic. By the was deemed to show in cases of headache it is
saw dr s and explained that early hours of the morning, reasonable judgment. important to consider it.
she was worried because Miss H seemed unchanged. He advised Miss H what ■ patients do not necessarily
she did not normally get she said her headache she could expect if she know what is important
headaches. dr s established wasn’t any worse, so dr W was having a migraine about their history, yet
that Miss H did not have decided to discharge her. and told her what to do most diagnoses are
any other symptoms and although she did not if her condition did not made on history. it is up
reassured her that this was feel any better, Miss H improve as he predicted. to the doctor to find out
probably a tension headache. struggled downstairs the However, the experts were any potentially significant
He prescribed paracetamol following morning. she lost concerned that neither gp details that a patient
and advised Miss H to get consciousness at the breakfast had made a note of whether does not volunteer. in this
a good night’s sleep. table so her friends rang for the headache was, or was case, nobody established
Miss H missed her dance an ambulance. at the hospital, not, of sudden onset, and whether or not Miss H’s
class that evening and felt too a ct scan confirmed that had not recorded the intensity. headache was either of
ill to work the following day. she had had a subarachnoid an expert in emergency sudden onset or its true
she went back to her gp haemorrhage. Before she could medicine was critical of the nature. this should be
practice, but dr s had no free be operated on, she suffered care given to Miss H at the asked and recorded in
appointments so she saw a a further haemorrhage. a&e department. Miss H cases where subarachnoid
locum dr a instead. When dr Miss H was left with had had a severe headache haemorrhage is
a heard that Miss H was now neurological disabilities. she for over twenty-four hours a possibility.
vomiting, he suspected that initiated a claim against the by the time she went to ■ When patients present
she was having a migraine. gps (both members of the hospital. dr W should have repeatedly over a short
He advised her to go home Mps) and the hospital. ruled out serious causes period of time with
and rest. dr a explained to of headache, such as symptoms that are not
Miss H that her symptoms subarachnoid haemorrhage. improving, it is important to
would probably improve over expert opinion from the a&e records it reconsider their diagnosis.
the next few hours. if not, he seemed unlikely that dr W do not assume that relevant
advised her to come back to gp experts were supportive had asked about the onset questions have already
the surgery or go to a&e. of certain aspects of dr and severity of the headache. been asked. eliminate
Miss H went home, but s’s care. His suggested the claim was settled by serious possibilities first.
sessional gp | voluMe 1 | 2009 www.mps.org.uk 13
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