To consider complaining to the GP practice

[OwdBets]

DH was feeling very sick last week. He went to the GP, explained his symptoms, stomach ache, vomiting, loose watery motions, light headed, clammy skin. He said he had not eaten for 36 hours.
She took his blood pressure, it was quite low. She did not examine his stomach.
She said it was a virus. Told him to drink plenty of fluids and come back if not better in 7 days.
DH lived on painkillers and water. He wasn’t sleeping or eating and getting worse each day. I must say he has a very high pain threshold. He waited the seven days, returned to the practice and saw a different GP who examined him, asked for a urine test and sent him straight to hospital.
DH was diagnosed with a ruptured appendix and had surgery at 1 am this morning.
Should the first GP have examined him? Should she have felt his stomach?
Should we complain?
I can’t help but think an examination could have indicated an issue with his appendix?

[lougle]

I think you're in shock, and it's natural to want to complain. I'm not sure that a complaint will be the best outcome for you.

FWIW, I think the GP should have checked his abdomen, and mine certainly would have done. However, I think a follow-up appointment when he's out of hospital will be useful, to review the course of events, and the GP will want to know the timeline and what they could have picked up.

I hope he gets better very soon.

[GwenStaceyRocks]

A stomach ache, an upset stomach, muscular pain, sharp pains - there are so many ways to describe stomach pain. If your DH used a description that sounded more like a stomach ache than an appendix pain, it would make sense for the GP to examine him for the former and not the latter.

[MajesticWhine]

I think a complaint is definitely in order. I’m not a big complainer but I do work for the NHS. These things need to be reported so that they can be prevented in future, and mistakes learned from.

[negomi90]

The problem about feeling an abdomen in gastroenteritis, is that it can often make it worse/the patient may vomit and patients don't like it when you do that.
From a clinical examination point of view - he would have been tender all over, appendicitis can start like that but so can gastroenteritis. Unless his pain was worse in his right lower bit (which your dh would have known without someone having a feel) or his abdomen was hard (ie you couldn't sqidge it) a clinical examination probably wouldn't have added much especially with the symptoms which sound like classic gastroenteritis.
Its very possible that your dh happened to get appendicitis right after having gastroenteritis (as an impressive piece of bad luck).
The GP should have examined his abdomen, but it probably wouldn't have made a difference to what happened.

I would write a polite letter to the practice explain what happened, and your concerns and questions and ask if anyone can talk you through/debrief you/address your concerns. Then escalate as needed depending on how the practise responds/how well you feel they address those concerns.

[RidingWindhorses]

Ok. Thanks everyone. We won’t pursue this.

No thats not the right conclusion.

I would contact them with the feedback that this GP missed acute appendicitis so she can improve her care. You don't want it happening to someone else.

Appendicitis can be hard to diagnose but the GP can hardly diagnose it if she doesn't check the abdomen. The low BP was a sign it wasn't simply a bug. A simple blood test would have then have shown it was a possibilty.

[saladdays66]

But if the first gp had examined his abdomen, he may not have felt anything as your dh’s appendix hadn’t burst at that stage.

Tricky. Your dh should have gone back sooner if his symptoms hadn’t improved.

Maybe you could write to the surgery and ask why the first gp didn't examine your h’s abdomen? Then you will have an answer.

[RidingWindhorses]

From a clinical examination point of view - he would have been tender all over, appendicitis can start like that but so can gastroenteritis. Unless his pain was worse in his right lower bit (which your dh would have known without someone having a feel) or his abdomen was hard (ie you couldn't sqidge it) a clinical examination probably wouldn't have added much especially with the symptoms which sound like classic gastroenteritis.

Sorry but I've had appendicitis and it wasn't until I had morphine and it couldn't kill the pain in the lower right that I became aware that area was worse than the rest. Before that the pain was across my whole abdomen. I was sent to a and e by the GP as my BP was low and my heart rate was fast. I was also writhing with pain tbf.

The a and e doctor did the press release test (can't remember its name) which showed the pain was worse on release on the lower right but my abdomen was not hard at all.

[SunnySkiesSleepsintheMorning]

I mentioned giving feedback before and I still think you’d be perfectly fine to do this. The GP who missed my serious illness phoned me and said she was devastated and sorry. That was really nice but I didn’t blame her. I saw her a while later, presenting with similar symptoms, and she was much more thorough, so clearly she had learned from her experience. As a professional, albeit a non health care one, I’ve not been offended when people have given me polite feedback when I’ve made small mistakes or even errors in judgement. We are humans, it’s how we learn.

[Floralnomad]

Giving feedback is always acceptable , I had 2 hospital admissions last year and on both occasions my potentially life threatening condition was missed , despite me actually telling them on the second admission what I thought was wrong with me . It’s very annoying and certainly people should be happy to accept feedback and hopefully learn from it where it is valid criticism .

[Jeanvaljean27]

Subacute or early appendicitis can be surprisingly difficult to diagnose. I see plenty of nonmedical posters upthread who've never examined an abdomen confidently asserting that if only GP 1 had examined, she have definitely elicited rosving's sign, McBurney's point tenderness and packed him off to hospital on day 1.

Doesn't work that way. Yes, there will be patients who have clear examination features of appendicitis. All doctors love those patients because guess what, the diagnosis is obvious as soon as you touch their abdomen. A reasonable proportion don't have any of those examination features. Even general surgeons who spend their lives palpating abdomens have a frequently poor pickup rate of what is appendicitis and what isn't from examining the abdomen.

It's why we have an actual term in surgery for an appendix that is not infected that is taken out because the surgeon diagnosed appendicitis and then found the appendix was fine when he opened the patient up to look. It's called a 'lily-white appendix'.

So yes, good practice indicates the GP should be examining everyone. She'd however then need half an hour per appointment instead of the ten minutes she has, which means she sees a third as many patients per day and your husband waits 3 days for his appointment rather than be seen today. So the GP picks and chooses who she'll examine on the basis of how suspicious their symptoms sound. In the overwhelming majority of young men presenting with vomiting, reduced appetite, vague abdominal pain the diagnosis will be a viral gastroenteritis. She (and you) were simply unfortunate that wasn't the case here.

[lovemylover]

I would definitely complain, she should have felt his stomach,
Too many Drs say its a virus,or caused by stress
A friend of mines brother in law went to see a Dr at his [and mine] surgery, he had a very bad pain in his back, she didnt even examine him or take his blood pressue etc, the day after he died his aorta burst
She was on the front page of our local paper, she was prosecuted but is still practising
The article said she had failed in her duty as a GP in not doing a proper examination, and should at least have taken his blood pressure, she had said it was muscular
I wont go to her, she will not even give a repeat prescription, even if its deemed to be neccessary

[RidingWindhorses]

Subacute or early appendicitis can be surprisingly difficult to diagnose. I see plenty of nonmedical posters upthread who've never examined an abdomen confidently asserting that if only GP 1 had examined, she have definitely elicited rosving's sign, McBurney's point tenderness and packed him off to hospital on day 1.

Only one poster actually said that tbf. The first poster to mention it said that while the GP should have done it, her own doctor husband got it wrong at first. And I said that without it you haven't got much hope of distinguishing appendicitis from gastroenteritis. Whether it would have yielded a positive result is a moot point as she didn't do it, and it's not definitive anyway.

I'm not convinced it was that early. He had the same symptoms as me and they meet all the criteria for acute bar a fever, which I didn't have at the point I was admitted.