A GP failed to spot the “red flag” warning signs of bowel cancer in a patient misdiagnosed with irritable bowel syndrome, the Ombudsman has ruled.
The Scottish Public Services Ombudsman investigated a medical practice in Tayside and upheld a complaint that a woman in her forties suffered a delay in diagnosis and was not given an urgent referral.
The woman, who cannot be named, said her doctor did not deal with her symptoms and she believes an earlier referral would have avoided the need for emergency surgery she later had to go through.
In a report, the SPSO investigator said: “Mrs C was diagnosed with bowel cancer late in 2012. She had been regularly attending her medical practice with a number of symptoms for some time and had been diagnosed with irritable bowel syndrome in the August of that year. “Mrs C told me that she had to request a referral to a specialist and, when her GP then made the referral, they classed it as routine and not urgent.
“Her symptoms then got worse and the practice tried to speed up the referral.
“After she was seen as a result of the referral, Mrs C was diagnosed with cancer and needed surgery.”
The woman complained that the practice had not provided adequate care or made appropriate referrals but the practice told the investigators they considered that the combination of her symptoms and her relatively young age did not require an urgent referral.
Giving professional advice to the investigation, an experienced GP criticised the care provided, saying the woman has a number of symptoms classed as ‘red flag’ but the practice did not respond appropriately.
The adviser also pointed out that for more than three years GPs in Scotland have been encouraged to pursue an early diagnosis of cancer if a patient over the age of 40 is displaying red flag symptoms.
The investigator concluded that, given her age and symptoms, the woman should have been urgently referred no later than September 2012, instead there was a non-urgent referral, by late November 2012.
Concern was also raised over whether it was the GP or the patient who eventually suggested the referral as the quality of clinical records were poor, lacking detail and clinical findings.
The investigator said: “I made a number of recommendations to ensure that individual GPs reflect on their actions and that the practice sample and review case notes to ensure these meet required standards.”
The practice accepted the recommendations, which included a written apology for the failures, the doctor responsible for treatment reflecting on the matter, reviewing guidelines and General Medical Council guidance on record-keeping.