Mr E, a 52-year-old truck driver, visited his GP, Dr G, complaining of a tight chest. Mr E had no significant co-morbidities, but had been suffering with coryzal symptoms for more than a week, which were starting to affect his breathing. He had wanted to attend sooner, but due to his job he had not been able to attend the surgery earlier. During the consultation Mr E mentioned that his throat has been bothering him for a couple of weeks, so he had started to cut down on his usual 20 cigarettes a day.
After examining Mr E’s chest, Dr G was quite concerned about his widespread wheeze. He administered a nebuliser in the surgery, and gave him some smoking cessation advice, but did not investigate Mr E’s throat.
A few weeks later Mr E reattended with similar symptoms of wheeziness and a cough, which again required another nebuliser. He mentioned that one side of his throat was painful and this was documented in the notes, but his throat was not examined.
During the following month, Mr E attended the local ENT department for a previously organised appointment to discuss a “recurrent sinusitis problem”. While he was at the hospital, Mr E mentioned his ongoing right-sided sore throat to Dr W, the ENT junior doctor. Dr W suggested that Mr E “tell his GP to check it”.
A month later at a follow-up appointment at the ENT clinic, Mr E saw Dr S, who immediately examined his throat. It became clear that there was an abnormal mass in his right tonsil and further tests confirmed squamous cell carcinoma of the tonsil with neck nodes. There was a five-month delay in the diagnosis, which required more aggressive treatment and left a poorer prognosis.
The experts were critical of the management of Mr E by both Dr G and Dr W, so the claim was settled for a moderate amount.