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Case ref:201407186
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Date:January 2016
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Body:A Medical Practice in the Western Isles NHS Board area
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Sector:Health
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Outcome:Upheld, recommendations
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Subject:clinical treatment / diagnosis
Summary
Mr C complained about a GP during a home visit deciding not to refer his wife (Mrs C) to hospital. Mr C was particularly concerned that Mrs C had been treated with steroids during a recent hospital admission for a chest infection, and this was likely to affect her diabetes.
The GP said that, during the home visit, they considered Mrs C was suffering from diabetes and a flare-up of her chronic obstructive pulmonary disease (COPD - a disease of the lungs in which the airways become narrowed). However, they said there was no evidence of a chest infection. The GP said the steroid treatment was important for Mrs C’s COPD (although it had a negative impact on her diabetes control) and they encouraged Mr C to continue this treatment. The GP considered their actions were appropriate.
After taking independent medical advice from a GP adviser, we upheld Mr C’s complaint. In relation to Mr C’s concerns about the steroid treatment, we found that the GP acted appropriately by advising Mr C to continue this (as the benefit to Mrs C’s COPD outweighed the impact on her diabetes). However, the adviser explained that Mrs C had lower oxygen saturation levels than when tested 11 days earlier, and the GP should have arranged further investigation of this (which would usually be done in a hospital setting).
Recommendations
We recommended that the practice:
- apologise to Mr C for the failings our investigation found;
- ensure that the GP familiarises themself with the National Institute for Health and Care Excellence (NICE) guideline on COPD, in particular in relation to the assessment of oxygen saturation; and
- ensure that the GP reflects on the findings of our investigation at their next annual appraisal.