Delay in diagnosis of a cerebral tumour

Medical history

A 31 year-old woman consulted her GP (MDU member), complaining that she had been suffering from headaches with nausea for some months. The patient had a long history of depression and anxiety following the deaths of both her parents and problems within her marriage. The GP thought that the headaches were probably due to migraine and prescribed pizotifen. No neurological examination was made.

Three and a half weeks later the patient returned again complaining of headaches and '...pain all around the head...'. The GP noted possible restriction of neck movement and prescribed chlordiazepoxide and a collar. Again no neurological examination was made. At another consultation two weeks later, the GP recorded that the patient had no further headache. (This visit was for treatment of injuries sustained during an assault.)

Six weeks later another GP in the practice (member of another defence organisation) saw the patient, again because of headaches. He recorded '...sounds migraine? vascular origin...', and prescribed clonidine. No neurological examination was made. The next day the patient's GP was called to see her at home with the same problem. The GP took the patient's temperature and examined her neck movement, which was restricted, but the only neurological examination was to check the patient's pupils. This time the GP prescribed phenazocine. No follow-up was arranged. The following day the patient's daughter telephoned the surgery to say that her mother again had a headache. When yet another of the doctors in the practice returned the call that afternoon, he was told that the patient was now better and did not need a home visit.

The patient was not seen again in the surgery before her sudden death at home some two and a half months later. Post mortem examination revealed a cerebral glioma.

Negligence alleged

It was alleged that all three GPs had failed to recognise that the patient was suffering from organic neurological disease some 15 months before her death. As a result, she had experienced pain and suffering that could have been avoided, prevented or reduced.

Expert opinion

The advice of an independent GP expert was sought by the MDU on behalf of the member. It was the expert's opinion that frontal lobe tumours are rare and that their signs are frequently late in onset. As a result, they are often missed both in hospital and in general practice. While it was possible that a very astute clinician might have diagnosed the condition some five and a half months before the patient's death, he did not think that the average GP would have done so. Moreover, even if the tumour had been diagnosed at this time, it was unlikely that the patient's prognosis would have changed. Given the history of continued headaches, however, it was felt that the standard of care by the patient's GP, and another of the GPs in the practice, in the five and a half months before the patient's death, had fallen below acceptable standards. The case was therefore settled out of court by a payment of £8,500 (75 per cent MDU; 25 per cent another defence organisation).

This page was correct at publication on 01/01/2002. 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.