Decision report 201102226

Summary

Mr C complained that his medical practice failed to provide reasonable treatment and advice to him in relation to peripheral vascular disease (PVD), a condition causing narrowing of the arteries. He attended his practice for a number of years complaining of leg pain, which the GP attributed to back problems. In 2011, after a deterioration in his condition, Mr C was admitted to hospital where he learned that he had been diagnosed with PVD in 2005. He complained that he was not told about this diagnosis and was not treated for PVD. He believed that this led to years of unnecessary pain.

We found that, as well as PVD, Mr C had serious back problems that ultimately needed surgery. Our medical adviser said that both conditions could have caused leg pain. At the time of being diagnosed with PVD, however, Mr C was in his forties. Our adviser said that diagnosis at this age was relatively unusual and, as such, Mr C's case should have been investigated, possibly with immediate referral to a specialist. Mr C's GP had prescribed aspirin and told him to stop smoking. On balance, we considered that this would have been reasonable if Mr C was supported to stop smoking and was monitored via regular blood pressure checks. However, we found no evidence in the clinical records that Mr C's GP made him aware of the diagnosis, nor that there was any support provided to help him stop smoking, nor regular monitoring of his condition. We, therefore, upheld the complaint and made recommendations.

Recommendations

We recommended that the practice:

• apologise to Mr C for the issues highlighted in our investigation; and
• review and discuss Mr C's case at a practice meeting to identify where improvements can be made to record-keeping and the treatment of future patients.