A 26-year-old woman attended her GP over a five month period with symptoms of irritable bowel syndrome, and with prolapsing and bleeding haemorrhoids. Three months into the illness, symptomatic treatments had not worked and the GP wanted to carry out a rectal examination. The patient refused, but no written record of the refusal was made.
Two weeks later, the patient returned and asked for an examination and surgical referral. The GP decided to defer the examination until the patient's next visit, because of her '...obvious pain and discomfort...' Unaccountably, the referral letter was not written for a month, but the patient was seen at the hospital only three weeks after that.
A senior surgical registrar found a large posterior polyp and arranged the patient's admission for biopsy. But the planned admission was overtaken by events, as the patient had to be admitted as an emergency shortly afterwards because of continuous rectal bleeding. A very low carcinoma of the rectum was diagnosed and an abdomino-perineal resection followed.
The MDU's expert was critical of the GP for not insisting on an examination (undocumented refusal would not be an acceptable defence), for deferring it at the next opportunity, and for the delay in sending the referral letter. The maximum delay for which the GP could be held responsible was a little under eight weeks, and the MDU therefore sought additional opinion from a surgeon on the question of causation.
Did the negligence actually result in the harm alleged? The surgeon felt that the tumour would already have been present well before the initial symptomatology, and that its position would always have required an abdomino-perineal resection.
The patient's life expectancy would have been largely unaffected by the delay. The patient's experts were of much the same view, and the claim was therefore settled for the relatively modest sum of £7,500.
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