The MDU defended the member throughout the claim and the case was heard at trial. The judge described the member as an impressive witness, who considered their answers and came across as a careful and conscientious clinician.

The member said that while infective endocarditis was part of their differential diagnosis, from a long list of potential conditions, there were no cardinal signs such as persistent fever, night sweats, weight loss, tachycardia or a heart murmur. Having considered the blood test results, the raised inflammatory markers could have been due to a variety of possible causes.

The member believed that the patient's condition needed further clarification and assessment, and that the raised CRP and ESR were not in themselves significant, given that the patient had recently suffered from diverticulitis and a possible urine infection.

The judge held that given the mortality and morbidity risks of infective endocarditis, if there were reasonable grounds to suspect it in a patient with a prosthetic valve, a GP would be falling below the standards of a competent doctor if they failed to refer that patient to hospital.

However, the judge also said that there was very little to suggest that the complaints were due to infective endocarditis at the patient's first consultation. The blood test result showed non-specific inflammatory markers that needed further investigation, and the member put this in place by arranging a further appointment. The judge concluded that when reviewing the blood test results, the MDU member did have infective endocarditis in mind as a possible, if unlikely, diagnosis.

The response to direct another routine appointment rather than immediate admission to hospital was deemed to be that of a competent GP, and judgment was made for the defendant.

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Successful defence of a high value claim