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A 20-year-old mistake

01 January 2010

Ms V attended her GP, Dr U, at age 15 complaining of unexplained pain in the area of her right hip, groin and knee. She was a keen netballer, but did not recall any episodes of trauma that had precipitated the symptoms. Dr U performed a cursory examination and deemed the patient to be systemically well, with no evidence of hernias, and no abnormality of gait.

The symptoms started soon after playing netball so he diagnosed a muscle sprain and gave the patient some cream to rub on the affected area. He advised her to return if there was no improvement. It was a busy clinic so his documentation of the consultation was brief.

Ms V reattended with the same problem again a week later and then again with her mother after a month, when she felt that the cream had been ineffective.

Dr U persisted with his initial conservative management of analgesia and advised Ms V to stop playing netball. Some months later, Ms V began to experience similar symptoms in her left hip and groin area. She was continuing to play netball, but denied suffering any injuries or trauma to the area. Dr U examined her again, but found nothing of concern on physical examination. Once again, he diagnosed a muscle sprain and advised a similar course of management.

Ms V claimed she did not like taking painkillers, so Dr U recommended a course of regular simple analgesia along with a course of physiotherapy, but the latter did not ever take place. Again, his documentation was scant since he had another busy clinic to complete.

For the next 20 years, Ms V continued to suffer intermittent pain in both hips, for which she took analgesia when it became unbearable and avoided strenuous activities. She never revisited her GP with this problem, as she felt she would be given the same advice. After a promotion at work, Ms V changed address and registered with a new GP. She told her new GP that she had suffered ongoing pain in both hips since she was a teenager and was keen to have this investigated.

The new GP checked her records and realised no previous radiology had been performed, so referred her for x-rays. The x-rays showed degenerative changes to both hip joints. The changes were reported to be consistent with previous bilateral slipped upper femoral epiphysis. At the age of 35, Ms V was required to have a bilateral hip replacement.

Ms V embarked upon a claim against her original GP surgery, where she had been treated as a child. The notes were retrieved and the documentation relating to her treatment was found to be extremely limited, with no indication that a proper examination had been carried out on any of the occasions she had attended.

Expert witnesses deemed the action of Dr U indefensible, in view of the lack of documentation and failure to investigate the symptoms further in light of the repeat attendance. The claim was settled for a high sum.

Learning points

  • Claims can often happen many years after an event. 
  • Adequately assessing a patient’s condition including, where necessary, a full examination of the patient is an essential part of clinical care. 
  • An overweight 10 to 12-year-old who presents with knee pain should be considered to have a slipped upper femoral epiphysis until proven otherwise. 
  • It is just as important to investigate and perform assessments of common ailments, like muscle sprains, in order to rule out the more serious conditions.
  • Don’t be immediately led to a conclusion of a “sprain” because of a history of sporting involvement. 
  • Beware of repeat consultations about the same issue. When symptoms persist in the face of continuing treatment, it is important to revisit the patient’s history and diagnosis. In this situation, further investigations should have been considered or, at the very least, a second opinion from another professional should have been sought. 
  • Don’t be afraid of reviewing a previous doctor’s diagnosis. 
  • It is crucial to listen to the patient – they will usually tell you the diagnosis. If you don’t listen, there is always the danger that they won’t come back.