The scene

A GP contacted the MDU requesting advice after receiving a complaint from a patient. The patient alleged that she had phoned the surgery on two occasions requesting an appointment for ongoing abdominal pain but had not been seen in person, and that this had led to a delay in being diagnosed with appendicitis.

The patient complained that the delay in diagnosis made her appendectomy more difficult and caused her to have a more protracted post-operative course.

MDU advice

The GP contacted the MDU for guidance. He said he had spoken over the phone with the patient, who described a one week history of waxing and waning grumbling pain in her lower abdomen. She denied any chance of pregnancy. The GP suspected that the patient had a UTI and asked her to drop off a urine sample, prescribing an antibiotic. The urine sample tested positive for red blood cells and leukocytes.

A week later the patient called back and spoke to the same GP. She explained that her abdominal pain came and went but was becoming more constant and persistent. The GP prescribed a different antibiotic. Four days later the patient phoned the surgery for the third time. She spoke with another doctor and an appointment was made to review her in person. The GP's colleague was concerned about the patient's presentation and suggested that she go to hospital. She was subsequently diagnosed with appendicitis and underwent surgery.

The MDU adviser empathised with the difficult balancing act faced by GPs undertaking telephone appointments, deciding whether or not a patient requires face to face review’. The adviser suggested the GP respond to the complaint by explaining why he had suspected a UTI, and setting out the factors that led him to this conclusion.

The adviser recommended that the practice hold a significant event review to consider whether, in hindsight, the GP and his colleagues felt that it might have been appropriate to review the patient in person when the patient described persistent symptoms. The adviser explained that if, after discussion with his colleagues, the GP concluded it would have been helpful to arrange to see the patient in person, it would be appropriate to say so and to explain how the GP's practice had changed in light of these events. However, if the GP and his colleagues were content that he had provided suitable care, it would be appropriate to sensitively explain this.

The outcome

With the assistance and support of the MDU adviser, the GP wrote a response to the patient expressing his regret that she had undergone a worrisome and difficult experience. In the letter, the GP described each telephone consultation and detailed his thought process. He explained that in order to learn from these events, the practice had reviewed the concerns raised in an anonymised way. The GP acknowledged that, in hindsight, it might have been helpful to have seen the patient when her symptoms did not settle.

The GP explained that he had reflected on these events at length and concluded that he would now have a lower threshold for reviewing a patient with persistent symptoms in person, in order to make sure a similar situation did not arise in future. The patient did not pursue the complaint.

Remote consultations and delayed diagnosis

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