L EGAL I S SUE S
if these coincide with other pains. Yet the consequences can be life-altering; cauda equina syndrome might be missed because a patient is deemed to have no ‘bladder problems’, rather than detailing the specific lack of sensation they may be experiencing in the saddle area.
The extremely time-sensitive nature of cauda equina syndrome treatment therefore means that the language used in consultations must be specific and succinct. Clinicians need to be direct in their questioning when a suspected cauda equina syndrome case arises. Repetition and using colloquial language will also be key. Questions must be posed to patients that hit directly at the problem rather than posing vague questions such as “have you got any bladder or bowel problems?” Most people will not know what this question is getting at. For example, we would suggest repeating questions but changing the wording used to find language that people most resonate and feel comfortable with during a consultation to support better outcomes. For example, “does it feel numb or different when you are wiping yourself after spending a penny?”, would be a more appropriate question. Of course, this is a two-way process and we must work to reduce the stigma around discussing intimate symptoms so that
patients feel comfortable talking about them. Increased awareness of this rare condition among both clinicians and patients will also support faster diagnosis. Public awareness- raising campaigns on the symptoms of the condition are also vital to build knowledge of the condition and encourage patients to be open about what they are experiencing, no matter how embarrassing they may seem.
Conclusion
Misdiagnosis of cauda equina syndrome often results from problems with communication between patients and their clinician. While the onus of improving this lies not necessarily with doctors and lawyers themselves, an awareness raising campaign targeted at the general public, such as cauda equina syndrome awareness day on 1 October, is a step in the right direction. Awareness campaigns help the public to understand the importance of speaking in detail about their symptoms, and they place rare but severe conditions like cauda equina syndrome firmly on the public radar, where they may not have been before. Cauda equina cases are costly both in terms of potential compensation pay outs and the long-term health burden that the NHS has to bear; not to mention the devastating impact on the individual. NHS Trusts should support these types of
campaigns as improved recognition will not only be beneficial for better patient outcomes, but ease the pressure at the moment when a fast and correct diagnosis is required.
CSJ
About the author
Maya Sushila is a partner in Moore Barlow’s medical negligence team, helping clients with complex claims resulting from substandard healthcare and medical practices. She has a particular interest in handling cases of cauda equina syndrome.
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