Coincidences can happen

The scene

The on-call doctor recorded that the pain was not increased upon exertion or with food. The patient's blood pressure was found to be 140/80. The doctor diagnosed gastritis and prescribed Omeprazole.

Two months later she saw a GP from her own practice as an emergency patient complaining of chest pain that had started three days previously. On examination she complained of tenderness in the centre and left of her chest. She was slightly short of breath and said that the pain was worse on severe exertion and when taking deep breaths. She described the pain as constant. Examination revealed tenderness over the left upper chest. No record was made of the patient's blood pressure.

An ECG was normal and the GP diagnosed musculoskeletal chest pain and gave advice on analgesia. The doctor recorded advising the patient to return or contact the out-of-hours service if her symptoms changed or were not settling.

The patient attended the surgery on a further six occasions but did not complain of any further chest pain during those visits.
Eight months later, the patient was taken to hospital by ambulance where she was diagnosed with acute coronary syndrome and non Q wave myocardial infarction. She underwent an angioplasty and stenting and made good recovery.
Two years later the GP from the patient's own practice, an MDU member, received a solicitor's letter. The letter claimed that the GP should have referred the patient for urgent cardiological assessment. It was alleged that, had a diagnosis been made earlier, the patient's condition could have been treated before it became acute and thus she would have been spared the trauma and pain of hospital admission. The patient was claiming a small sum in damages for permanent damage to her heart and for the pain and suffering which resulted from the delay in diagnosis.

The outcome

The MDU commissioned expert reports from a GP and a cardiologist.
The cardiologist felt that the GP's initial diagnosis was correct. Given the normal ECG, and given that the pain was associated with chest wall tenderness, he expressed real doubts as to whether the claimant had cardiac chest pains during the initial consultation. In addition, the patient did not mention chest pains during the consultations with the other GPs in the practice in the intervening period between the initial presentation and the hospital admission.

Both the GP and cardiologist experts agreed that the presenting symptoms would not have justified an immediate referral. Even if the patient had been referred for outpatient cardiological assessment, given likely waiting times for referrals and routine investigations at the local hospital during this period, it was unlikely she would have had an angiogram before the event which led to her hospitalisation.

As a result the MDU sent a letter of response to the claimant's solicitor denying liability. It made clear that experts agreed it was unlikely the chest pain their client had on the day of the consultation with the GP was cardiac, and, even if it was, it was most unlikely that investigations would have avoided emergency admission.
Three months later, after receiving the MDU's letter rebutting the claim, the claimant's solicitor wrote stating that she no longer wished to pursue the case.

This page was correct at publication on 22/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.