Telescoping symptoms

The GP arranged a referral to a physiotherapist. During the consultation he also checked the patient's blood pressure and, following discussion, arrangements were made for the patient to attend the practice nurse in January 1997 for a blood test to measure his cholesterol level.

In February 1997 the patient was advised that his cholesterol level was high. In light of a family history of heart disease, the GP prescribed a course of statins and arranged for another cholesterol test in one month. The GP made a written note of the consultation which included the observation 'Wt«1 stone'.

There was no record of any further consultation, and shortly afterwards the patient moved to another area and registered with a new GP.

Some years later the patient was diagnosed with hypothyroidism, and in the spring of 2006 he began proceedings against the GP he had seen in 1996.He alleged this doctor had been negligent in failing to make the diagnosis in that year. Later he amended his allegations to failure to consider the diagnosis of hypothyroidism by not inquiring directly about the relevant symptoms and signs of hypothyroidism.

The patient claimed that he had been generally healthy and a keen sportsman until his 30's, but that in 1995 he had begun to feel more 'lethargic' and not able to do as much as he had previously, something that he attributed at the time to the stresses of running a business. He claimed that his condition would have been diagnosed earlier had the GP arranged for him to undergo athyroid function test after his fasting cholesterol level was found to be high.

 

The outcome

The case went to the High Court where the GP was represented by the MDU. In court, the GP agreed that he had not inquired into a possible diagnosis of hypothyroidism because the claimant had informed him during the February consultation that he had lost a stone in weight on a low fat diet. Had he not been told about these changes he agreed he would have enquired further about the patient's symptoms in order to consider a possible diagnosis of hypothyroidism. He also accepted that he would have considered doing tests such as LFTs and blood glucose to establish other possible causes of the elevated cholesterol.

The patient claimed that his weight had started increasing from 1995 and in his original witness statement he said he was unable to lose weight and seemed to be continually on diets and exercise. In court, he was asked whether he had drawn the doctor's attention to the specific question of weight gain. He responded that the weight gain was a consistent thing, but he could not remember whether he had specifically mentioned it to his doctors.
 
Central to the dispute was the meaning of the entry 'Wt « 1 stone' in the clinical notes. In a supplementary statement, the patient said he could not remember telling the GP that he had lost a stone but that he had been advised to lose a stone. However, the patient modified his position before being cross-examined stating instead that the GP had told him to lose weight. He could not remember a specific figure.

In his original witness statement the GP had no specific recollection of the consultations over a decade before. However from his notes he said it was clear that the patient was on a low fat diet and had lost a stone in weight. He said: 'It is clear from this note that (the patient) reported that he had lost a stone in weight... If I had advised him to lose a stone in weight I would have recorded this in the note. For instance I would have written, 'Advised to lose weight', or 'Advised « weight'. I would not in any event have advised (the patient) to lose a particular amount of weight... as it would not have been my place to do so.

'Both GP expert witnesses agreed that, had the GP been told by the patient that he had lost a stone, he would not have been negligent not to have investigated a possible diagnosis of hypothyroidism. Two consultant endocrinologist experts agreed that the claimant was 'most unlikely' to have been hypothyroid in 1997 if he had lost a stone in weight.
 
In summing up, the judge said he felt that the claimant had 'telescoped' his symptoms back to the period in1995 prior to his consultation with his GP. It was significant that there was no mention in any of the notes prior to 1998, by any of the doctors who had seen the patient, of a possibility of hypothyroidism or any symptoms the claimant was now stating that he had been suffering from since 1995. In his Judgment he referred to the opinion of the claimant's expert endocrinologist 'who agreed that in his experience there was a tendency for those suffering from thyroid disease to tend to blame all their problems in their life on their disease'.

Finding that the GP was not negligent, the judge ruled that the patient was not suffering from hypothyroidism at the time of the February 1997 consultation. He concluded that the patient was looking back more than a decade, that his memory was to some extent 'playing tricks' about when symptoms arose, and that his hypothyroidism most likely developed after 1997 by which time he had changed GPs.

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.