Failure to diagnose pre-eclampsia
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Lost opportunity
Ms C, a 43-year-old smoker who was otherwise well, presented to her GP, Dr Q, complaining of a few days’ discoloration to the tip of her right index finger. She explained that her fingers had always felt cold and often turned white and went numb when she was outside.
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If it is not recorded
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Stretch marks and steroids
Mr A was a 25-year-old man who was on lifelong steroid medication for congenital adrenal hyperplasia. He was under the care of Dr F, a consultant endocrinologist.
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Tragic outcomes don't always equal negligence
JS, a four-month-old baby, was felt by his mother to be developing a cold and was given oral paracetamol solution, which was effective. The following day his mother noted he was warm and snuffly.
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Undescended testis
Baby LM was taken to see his GP, Dr E, for his six-week check. During this examination Dr E noted that his left testis was in the scrotum but his right testis was palpable in the canal. He asked LM’s mother to bring him back for review in a month.
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Failure to follow specialist advice
Following a hospital admission for status epilepticus, which was attributed to a previous cerebral insult, Mr G, a 35-year-old clerical officer, was started on an anticonvulsant regime of phenytoin and sodium valproate.
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Missed meningitis
A Missed opportunity?
Back to front
An unusual presentation masks a significant underlying diagnosis
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Paediatric brain injury
Surgery for an arachnoid cyst is complicated by an intracranial bleed.
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A risk of harm
An unlucky tummy tuck
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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