Common complaints

MPS senior medicolegal adviser Dr George Fernie looks at some common complaints received in general practice

Delayed diagnosis of prostate cancer

Seventy-year-old Mr M attended his local GP surgery as he noticed blood in his urine. The nurse found a trace of blood when analysing the results of a urine dipstick test. The test was repeated two weeks later and there was still a trace of blood, so she sent the MSU to be screened. There were no red cells and nothing else was seen so nothing else was done about the complaint.

A year later, Mr M returned to his local practice for another test and more blood was found in his urine, as well as ongoing urinary frequency. The MSU tested negative for infection except for one blood but was filed as OK.

Four months later Mr M went to see his GP and said there was blood in his urine but the MSU and dipstick tested negative. The Prostate Specific Antigen (PSA) blood test was done along with a rectal examination which revealed that the prostate was smooth but enlarged. There was then a two-week wait for a urology appointment made due to elevation of the PSA.

At the clinic Mr M was diagnosed with prostate cancer. Mr M was very angry with the delay in diagnosis and filed a complaint against the nurse and the GP.

Learning points:

Have a robust system for dealing with results, especially when they are borderline.
Make sure you are aware of guidelines in respect to management of asymptomatic haematuria.
Know how to deal with PSA results and parameters for referral in different age groups.
Keep an open mind on differential diagnoses.
Be aware of Medical Council guidance on how to respond if something has gone wrong.

An immunisation error

A mother brought her four-month-old daughter, Ellie, to the local GP practice to receive her second routine vaccinations. The GP, who was new to the practice, administered the 6 in 1 vaccinations and also the PCV (Pneumococcal Conjugate Vaccine).

Before performing vaccinations, health professionals should be trained, competent and familiar with the immunisation schedule

Only when the GP came to record in the baby’s records did she realise that she had given the pneumococcal instead of meningococcal vaccination. When the baby’s mother found out she was very angry and made a complaint to the practice.

Learning points:

The GP was unfamiliar with the immunisation schedule. Before performing vaccinations, health professionals should be trained, competent and familiar with the schedule.
If possible, the immunisation schedule should be displayed on the outside of the fridge so that it can be clearly seen.
The fridge should be arranged so there are labels on each box with the name of the vaccine and when it should be administered.
The GP should have explained to the mother what vaccinations the baby was having, and should have taken informed consent.
Hold a Significant Event Audit (SEA) at the practice. Investigate the incident thoroughly and inform the family of what is being done.
Adopt a policy of openness to encourage full and frank discussions with staff involved in significant events.
Carefully examine the steps that led to the incident.
Identify areas to improve patient safety.
Feed back the findings to the family.
Support the staff involved in the error and consider their learning and training needs.

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