Tunnel vision
A patient presents several times with a worrying vaginal discharge
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Tripped up
Turning a blind eye
A delay in sharing an urgent result with a patient results in a loss of vision
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Diathermy Drama
Minor surgery to remove a skin tag is complicated by an unexpected event
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A hidden problem
Mr T, a 40-year-old accountant, attended a private health check under his employer’s healthcare scheme. Blood and protein were noted on urinalysis and his eGFR was found to be 45 ml/min/1.73 m2. He was asked to make an appointment with his GP and was given a letter highlighting the abnormal results to take with him.
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A friend in need
Ms N, a 33-year-old female accountant, presented to Mr X, a consultant orthopaedic surgeon, with severe lower back pain radiating to both legs.
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A complicated claim
Mr A, an orthopaedic surgeon, was approached by a claimant’s solicitors to provide an expert report on behalf of their client.
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No news is not always good news
Child J, a one-week-old baby girl, was noticed to have a clicking right hip when she was seen by the community midwife. A referral to the orthopaedic clinic was requested and Child J was reviewed by orthopaedic junior doctor, Dr M, three weeks later. Dr M confirmed that there was no relevant family history and examined Child J.
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Reported abuse
Mrs X asked her GP to refer her eightyear-old daughter, Child F, to be assessed by a consultant psychiatrist in child and adolescent mental health. The GP referral letter stated that Child F had reported to her teacher that her father frequently touched her genitalia.
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Back to basics
Mr B, a 42-year-old builder, attended his GP, Dr S, with a three-week history of back pain and left sided sciatica. Dr S found nothing of concern on further questioning or examination, so made a referral for physiotherapy and recommended ibuprofen.
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Lost in translation
Mrs S, a 27-year-old Romanian woman who lived with her husband in the UK, became pregnant and presented to her local GP surgery to commence antenatal care. Mrs S did not speak English and usually brought a family member with her to interpret.
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We need to talk about death
Mrs S was a 36-year-old patient diagnosed with a benign giant cell tumour of the sacrum. She was seen by Mr A, consultant in orthopaedic oncology, and listed for resection of the lesion.
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Repeating the risk
Mrs L, a teacher, was first prescribed the oral contraceptive pill microgynon by her GP, Dr G, when she was 17. Her blood pressure was taken and recorded as normal. At this time, no other mention was made in the records of her risk profile or family history.
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Poor notes, fatal consequences
Mrs Y, a 39-year-old chef, opted to M see consultant obstetrician Mr B for private antenatal care. It was her first pregnancy and other than a BMI of 30 she had no pre-existing medical problems.
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Elbow Arthroscopy radial nerve injury
Mr P, a right-handed project manager, developed a stiff right elbow following a previous injury, and had reached the limit of his progress with physiotherapy. X-rays showed degenerative changes and he was referred to an orthopaedic consultant, Mr A, who diagnosed osteoarthritis of his elbow.
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Failing to act on tonsillar cancer
Mr K was a 36-year-old man who ran a pub. Mr K smoked and drank heavily. Mr K’s dentist had noticed a painless swelling on the right side of his neck during a routine check-up and asked him to see his GP.
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Death by Diarrhoea
Mrs B was a 27-year-old secretary with a ten-year-old daughter. She had just enjoyed a trip to Pakistan where she had been visiting relations. Three days after her return she developed profuse, watery diarrhoea.
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Living up to expectations
Mr G was a 62-year-old office worker; he was overweight (BMI 29) and suffered from exercise-related angina. Mr G had several risk factors for ischaemic heart disease including smoking, diabetes mellitus and hypercholesterolaemia. Following a positive exercise test, a coronary angiography confirmed triple vessel coronary artery disease with a left ventricular ejection fraction of 45%. He was referred to Mr F, a consultant cardiothoracic surgeon, for consideration of coronary artery bypass graft (CABG) surgery.
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Adopting a considered approach in a time of uncertainty
Case study - Missed critical limb ischaemia
Mr S was a 60-year-old lorry driver. He was overweight and smoked, and couldn’t walk far because he suffered with pain in his calves. This became so severe that he attended the out-of-hours service that evening.
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Case study - An early presentation
Baby T was eight weeks old when his mother brought him to his GP’s morning surgery.
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Case study - Cauda Equina Syndrome
When Mrs C, a keen golfer in her early 40s, began to experience constant pain in her lower back, she consulted a GP at her local surgery.
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Making an informed choice: MPS response to Department of Health state...
Making an informed choice: MPS response to Department of Health statement
Our approach is to make considered decisions that protect the long term interests of GP members, rather than making rash decisions that could have a long-lasting and detrimental impact on members.
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