INVESTIGATIONS: NOT ON THE X-RAY
BACKGROUND Mr D – a 64-year-old man – makes an appointment at his GP surgery complaining of persistent pain in his lower back made worse by gardening. Mr D has no previous history of low back pain but just over a year before he had undergone a total left hip replacement. One of the partners – Dr G – examines the patient and finds nothing of note. He gives Mr D guidance on proper lifting technique and advises use of over-the-counter analgesia at the maximum recommended dose.
A month later Mr D returns to Dr G with a
three-week history of pain in his left hip. He also complains that his foot is falling funny when he lies down flat in bed. The GP notes “restricted hip flexion on knee extension/pain in left pelvic rami”. Dr G is concerned that Mr D’s symptoms might indicate early failing of the hip replacement due either to loosening or infection. He orders an X-ray and again advises Mr D to persist with the analgesia. Two weeks later Dr G
receives the results of the X- ray: “Left hip prosthesis noted and appears satisfactory. Right hip normal.” Mr D attends to discuss the result
and Dr G explains there appears to be nothing amiss on the X-ray. He advises the patient to persist with the analgesia and return in two weeks if the pain has not settled. No other tests are arranged as they are not indicated by the X-ray results. Three months later an out-of-hours GP
refers Mr D to hospital having developed an abscess on his hip. Further investigation reveals an infection around the hip replacement. Mr D remains in hospital for another six weeks and has a further hip replacement which fails again due to infection. Six months later Dr G is contacted by solicitors representing Mr D, investigating a claim of
negligence. It is alleged that Dr G should have requested further investigations or blood tests considering Mr D’s persistent hip pain.
ANALYSIS/OUTCOME Dr G contacts an MDDUS medical adviser and the GP is asked to provide a copy of the patient records and also to provide an account of the case. In his reply Dr G relates a full chronology of his encounters with the patient including a justification for the treatment decisions made. On the question of blood tests he writes: “In my judgement it was not necessary or helpful to order blood cultures as the X-ray did not indicate any problem. Even a raised ESR could be due to any number of causes in this age group.” MDDUS lawyers draft a robust response
to the allegations and the action is subsequently dropped.
KEY POINTS
● Be aware that infection can be a possibility even with a normal X-ray.
● Other complications of hip replacements include loosening
of the joint, dislocation, DVT and pulmonary embolism.
GDC:
JOURNEY HOME
BACKGROUND A dentist is driving home from the surgery one night and decides to take an alternate route to avoid temporary traffic lights on the main road. She is following a slow moving lorry on the unfamiliar road and looks away from the road for a moment to check her rearview mirror. Just then the road makes a sharp turn and the car drifts over the centre line sideswiping an on-coming vehicle. No one is hurt in the accident but the dentist is later convicted under Section 3 (careless driving) of the Road Traffic Act and ordered to pay a fine and her licence endorsed. A routine letter is sent from the criminal records department to inform the GDC of the conviction, which subsequently
SPRING 2012
contacts the dentist in regard to her professional conduct. The GDC letter states the information will go before a Preliminary Proceedings Committee and suggests it would be “helpful” for the committee to have her “observations” on the matter.
ANALYSIS/OUTCOME The dentist contacts MDDUS and an adviser helps to draft a letter explaining the circumstances of the accident and the fact that the dentist has an otherwise unblemished licence. She expresses remorse and insight, stating that she is a more cautious driver as a result of the incident. The dentist later receives a warning letter which she acknowledges in writing.
KEY POINTS
● Follow guidelines on reporting convictions and contact MDDUS before replying to GDC correspondence.
● Give a clear and honest account of any incident, showing insight.
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