Off the record conversation

The scene

A 45-year old male patient who was a smoker registered at a new GP practice and underwent routine urinalysis. This showed glycosuria, and a fasting blood glucose test suggested diabetes mellitus.

The blood glucose result was reviewed by the GP, who arranged for the patient to be contacted by telephone by one of the receptionists. The patient was advised to re-attend for a further fasting serum glucose test, in accordance with the practice's usual procedure.

However, the phone call was not recorded in the medical records because there was no system for doing this at the time. The patient did not attend for a further fasting blood glucose sample.

Six weeks later the patient attended the surgery again and saw a different GP. The patient complained of a productive cough and was prescribed antibiotics. This GP later remembered that he had advised the man to stop smoking and reminded him of the need to attend for a repeat fasting blood glucose sample. Unfortunately, this reminder was not recorded in the medical records.

The patient did not attend again until another month had passed and saw the second GP. On this occasion he complained of chest pain. The GP suspected myocardial ischaemia and arranged immediate hospital admission. An acute myocardial infarction was confirmed for which the patient received appropriate treatment. The patient's blood sugars were elevated and he was diagnosed as diabetic and started on insulin.

Two years later, the two GP members were sent a letter of claim. The allegations were that there was a failure to arrange for the claimant to undergo a repeat blood glucose test and a failure to diagnose and treat the claimant's diabetes mellitus. It was alleged that if this had been treated, the acute myocardial infarction would have been avoided.

The outcome

 

The MDU obtained expert advice from a general practitioner and a consultant cardiologist. The GP expert advised that if the patient was contacted and advised to attend to have a repeat fasting blood glucose test, then this would accord with standard practice. If the patient was not contacted following receipt of the abnormal result, then the standard of care would not be acceptable.

The expert further advised that, when the claimant attended with a productive cough at the consultation with the second GP, the GP would have been expected to review the most recent entries in the medical records. The previous entry recorded the abnormal blood glucose result.

If the second GP reminded the patient to attend for a repeat test, the expert concluded the management was reasonable. However, if the GP hadn't done so, then the standard of care would not be acceptable.

Both GP members appreciated that there might be an area of weakness in their case since neither of the reminders to the patient to attend for a repeat fasting blood glucose had been recorded in the computerised records.

The cardiology expert advised that, given that the period between the initial elevated fasting blood glucose result and the myocardial infarction was only three months, the myocardial infarction would probably still have occurred even if the claimant had received treatment for diabetes.
 
In the light of the expert advice, the MDU denied liability on behalf of both GP members. The claimant did not obtain any expert advice, and in the light of the MDU's robust defence based on expert advice, the claim against both GPs was discontinued.

This page was correct at publication on 20/12/2010. 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.