GPs warned about spinal nerve condition after MDU pays £12.5 million in compensation and legal fees
GPs are being warned about the importance of a prompt diagnosis of a condition which causes compression to nerve roots below the end of the spinal cord, to avoid patients suffering long term disability.
The Medical Defence Union (MDU) has paid out £8 million in compensation and £4.5 million in claimant’s solicitors’ costs to settle claims for alleged failure to diagnose cauda equina syndrome over the last eleven years. The majority of these cases involved GPs, some working out-of-hours, an article from the latest MDU Journal explains.
Dr Grace Cheung, MDU medical claims handler, commented:
“Cauda equina syndrome is a medical emergency caused when a patient suffers compression to the nerve roots below the termination of the spinal cord, most commonly as a result of a slipped disc, although it can sometimes be caused by an infection or tumour.
“This is a difficult condition to diagnose in its earliest stages, as symptoms of lower back pain are very common. Unfortunately, a failure to quickly refer a patient with cauda equina syndrome can have serious consequences for them, including paralysis, incontinence and impaired mobility. It’s important for GPs to be aware of potential symptoms to avoid delays in diagnosis.”
The MDU examined nearly 150 claims between January 2005 and August 2016 of which 92% involved GPs. More than 70% of the claims were successfully defended by the MDU incurring nearly £350,000 in defence costs. Of the claims that were settled, compensation payments ranged from £2,250 to £670,000.
MDU claims handler, Charlotte Taylor explained:
“Claims for alleged delayed diagnosis in cauda equina syndrome can be made for a large amount of money because the patient often has substantial care needs. If the patient can no longer work, but was a high earner with many years of employment ahead of them, this can equate to a very large compensation payment. The aim is to put the patient back in the position they would have been, but for the negligent injury.”
The MDU Journal article advises GPs to use their clinical judgement and consider the following factors to try to avoid delays in diagnosis of this condition:
- Conduct a full examination of the patient to establish the likely cause of the back pain and make a record that this has been done.
- Consider whether there are any red flags such as pain radiating below the knee bilaterally, lower limb numbness/weakness, numbness on either side of the buttocks and saddle area, bladder or bowel disturbance or erectile dysfunction.
- If symptoms are present, call the hospital orthopaedic or neurosurgical specialist for immediate advice, or if they are not available, arrange for the patient to be admitted to hospital via the emergency department.
- Give patients diagnosed as having back pain appropriate safety netting advice, including advising the patient of what symptoms to look out for and the importance of seeking urgent medical attention if these appear.
- Make a record in the notes to demonstrate you have actively considered the condition and provided safety netting advice.
Further on in the Journal, Dr Nia Wyn Davies explains how a prolonged period of illness gave her the opportunity to see the other side of the doctor/patient relationship. She explains that by finding even a few minutes to talk to and listen to patients’ needs, doctors can have an enormously positive impact on emotional wellbeing and the overall doctor/patient relationship.
