General Practioners (GPs)
GPs
Common Complaints about GPs
Questions to consider
Cancers
Fractures
Cervical Spine Injuries
Back Pain
Sudden Loss of Vision - Retinal Detachment
Ectopic Pregnancy
Acute Pancreatitis
Torsion of the Testicle
Prescriptions
GPs
GPs deal with the complete range of medical problems and conditions. This short summary cannot cover all of the situations that a GP will deal with every day. Some examples are set out below. Information about some of the conditions are set out in more detail in other pages.
Common Complaints about GPs
In our experience the most common reasons for complaint about a GP are:-
- Failure to visit a patient at home when requested (for example, non-specific illness where the history suggests a possibly serious cause or for acute abdominal pain)
- Failure to examine or investigate
- Failure to diagnose
- Failure to arrange emergency admission to hospital or refer to a specialist
- Delay in diagnosing a serious condition
- Prescription and drug treatment errors
As well as being a cause for complaint these can be also be the reasons for a medical negligence claim.
Questions to consider
In the particular circumstances:-
- Should the GP have arranged for the patient to be seen at home?
- Did the GP conduct a full enough examination and take (and record) an adequate history?
- Should the patient have been admitted to hospital or referred to a specialist?
- Was it reasonable to treat the condition as the GP did?
- Did poor communication between doctors lead to mismanagement?
Cancers
A GP has to balance the anxiety of referring a patient to a specialist for investigation of symptoms that may or may not be early signs of cancer against the dangers of a missed diagnosis of cancer. Early diagnosis will offer the opportunity of early treatment and will often (but not always) improve the outcome.
See also Cancers
Fractures
A GP is best advised to send any patient with a suspected fracture to hospital for an x-ray.
These signs of a potential fracture should arouse suspicion:-
- Deformity that can be seen or felt
- Local swelling
- Bruising
- Local tenderness over bone
- Loss of function (difficulty moving joint or using limb)
- Abnormal mobility (unable to stand or walk)
- Grating when the injured part is moved
See also Fractures
Back Pain
Only a small percentage of complaints of backache are referred to hospital. Symptoms that suggest the need for a referral are:-
- Under 20 or over 60 years of age
- Previous history of any cancer
- Significant injury
- Inflammatory disorders
- Past or present use of systemic steroids
- Persistent restriction in lumbar (lower back) movement
Symptoms of a prolapsed intervertebral disc are:-
- Back pain – severe shooting pain, perhaps locking the back, remaining as a dull ache. Eased by rest, certain positions, walking about. Aggravated by movement and coughing.
- Pain radiating down leg – is very suggestive of a prolapsed disc
- Difficulty in raising leg when laid on back
- Tingling/numbness of feet or back of lower leg
See also lumbar disc surgery in Spinal Surgery
Sudden Loss of Vision - Retinal Detachment
Sudden loss of vision is a serious and urgent matter requiring immediate intervention. Any patient attending the GP with painless, sudden loss of vision should be referred immediately to an ophthalmologist for diagnosis and treatment if there is to be any chance of saving the patient’s sight.
Retinal detachment is a possible cause of sudden loss of vision.
The retina is the light-sensitive layer at the back of eye made up of light-sensitive nerve endings and their supporting nerve and connective tissue. The retina is a delicate multi-layered nervous tissue membrane inside the eye that links with the optic nerve. It receives images of external objects and transmits the visual impulses to the brain through the optic nerve.
Retinal detachment is a separation of the retina from the back of the eye. As the layers separate there are symptoms of flashing light which goes as the separation completes. There may be a rupture of blood vessels causing a shower of floaters to be seen.
Retinal detachment can happen for two reasons:
- A hole in the inner retina causing fluid to detach the retina
- The presence of solid material (tumour, tissue, fluid from inflammatory causes or blood)
Retinal detachment causes loss of vision, which takes the form of a shadow or curtain spreading across the field of vision. The size of the visual loss varies according to the degree of detachment.
Patients usually seek advice from an optometrist first. If the diagnosis is not apparent but a change in visual status is noted, the patient should be referred to an ophthalmologist immediately. If the optometrist suspects the presence of a retinal detachment, he should inform the patient’s GP that the matter requires the urgent opinion of an ophthalmologist. The GP’s role is to arrange the earliest possible appointment if a retinal detachment is suspected. Early diagnosis and treatment may be vital factors in the restoration or preservation of eye sight.
Ectopic Pregnancy
An ectopic pregnancy occurs when the fertilised egg develops out side the uterus (womb), most often in the fallopian tube.
Patients complain of cramp-like, colicky pain, usually on one side of the abdomen. It can be confused with appendicitis. The pain is severe and is worse when moving. Ectopic pregnancy should be considered if a patient has vaginal bleeding and is possibly in the early stages of pregnancy with abdominal pain.
Undiagnosed and untreated, the natural history of the ectopic pregnancy with acute rupture of the Fallopian tube is death. The safe rule for doctors to remember is: lower abdominal pain in female patients of reproductive age is due to the presence of an ectopic pregnancy until proved otherwise. Doctors must not discount the possibility until it is known that a pregnancy test is negative.
If an ectopic pregnancy is suspected the patient should be referred to hospital because they can rupture and cause internal bleeding. This can be fatal.
Acute Pancreatitis
Acute pancreatitis is an inflammation of the pancreas. It is a serious condition and can be fatal.
Patients complain of severe abdominal pain (which radiates down the back), feeling sick, retching and vomiting. The patient tends to sit forwards because the pain is worse when lying flat.
If acute pancreatitis is suspected the patient should be referred to hospital.
Torsion of the Testicle
Pain in the testicle is a potentially serious condition. It could be caused by torsion of the testicle (testis), where the cord is twisted and cuts off the blood supply.
It is more common during the first year of life and during puberty. There is a sudden onset of pain (but can be more gradual in children) on one side. The testicle is hot, swollen and tender.
The condition requires urgent treatment because loss of blood supply for 6 hours may result in gangrene so that the testicle will have to be removed. Surgical correction in 5 hours of the onset of symptoms may save the testicle.
If torsion of the testicle is suspected the patient should be referred to hospital.
Prescriptions
When issuing a prescription the GP should make a diagnosis and choose a drug that is needed, effective to treat the condition, cost effective and with an acceptable risk (benefit ratio). The GP should discuss the drug with the patient and warn of common side effects and adverse reactions. The dosage, frequency and duration of the treatment should be clearly understood and agreed.
Repeat Prescriptions
GPs issue repeat prescriptions without seeing the patient. The patient should be reviewed periodically with the frequency of the review being determined by their condition. The GP should monitor the repeat prescriptions for overuse and under use (poor compliance)
Summary
This is only a very short summary of what is a complicated medico-legal topic. All claims for medical negligence require a detailed assessment of the factual, medical and legal issues surrounding the circumstances of the treatment. Raleys can help you find a way through this maze.
