GP misdiagnosed a condition, would you file a complaint?

[chatenoire]

Posting here for traffic. I went to my local surgery and got seen by GP A. Said GP diagnosed me with a chronic and life changing condition. Most ladies who suffer from it take months if not years to get a full diagnosis, a biopsy can be part of it. Normally diagnosed by specialist, but GP can diagnose if confident. I had only had symptoms for like 8 weeks and were not debilitating and I knew if I didn't cause them at least I made them worse. My symptoms didn't not match that condition.

The more I read about it, the more I started to question the original diagnosis. I also fully recovered within 48hrs and that diagnosis normally takes months to get back to remission. In the meantime, my cousin a dermatologist said that it was extremely unlikely to be what they diagnosed me with (it's a skin condition).

So I went back to the surgery to be seen by another GP. GP B said that as much as she could see where the original GP was coming from (although she said that would that never have been enough to give a full diagnosis), GP A definitely misdiagnosed me when you looked at the whole set of symptoms, circumstances, timelines, etc... and that I most certainly wouldn't have recovered so quickly. In fact I needed to stop the treatment cold turkey as it was going to cause more harm than good.

So the question is would you complain about GP A?

The test would be a biopsy, unless certain, so that would be a lengthy wait as it’s not done in primary care. I wouldn’t fancy 3 months of strong steroid cream either. I guess there’s a middle ground between doing nothing because you’re not 100% sure without biopsy, and going full-on with potent steroid.

Biopsy

That's more or less where I stand. She could have sent a milder steroid and see how it evolves (give it 10/14 days) and if not have a follow up. If no improvement then, referral or move on to the next strength level.

I've stopped the steroids and yeah I'm fine, I even had sex and had zero issues.

It’s difficult to know, obviously. The GP saw you and neither your cousin (presumably) nor we did. Second GP didn’t see you as you first presented either. In younger people LS is not a textbook presentation, from what I’ve researched.

My cousin being my cousin, did see my buttcheeks (just photos) but I did tell her the WHOLE lot of symptoms.

It was my face that made me question it as it's very uncommon to have LS on the face... I think if I had only had butt issues I wouldn't have questioned it.

Yes, I’d complain. How else will the doctor, surgery and more broadly profession continuously improve unless errors are analysed? Do it for data capture at least.

look at aviation. The smallest error requires reporting as a minimum, and various levels of investigation.

medicine needs to get with the program

If nobody ever tells GP about their misdiagnoses then how are they suppose to learn? Depending on the hierarchy in the surgery there is a solid chance that the colleague B won't say anything.

I understand medicine is a guessing game. I don't think anyone is calling taking this to a court and making sure ehe loses his license or anything. Just to make sure that next time he knows to order a biopsy. And yes, there are tons of jobs where either the client or manager does point out your mistakes. It might not have to be a formal complaint but a way to contact the GP or surgery to let them know what has happened.

To be fair, I'm still so angry how my bf has been thrown around by the GP in our surgery this week. Apparently the lump under his ribs and the inflammation around the spleen is stress related and doesn't need further investigation.

IMO if the aim is learning, then feedback rather than complaint is the way to go, so the clinicians can focus on the learning, rather than get defensive and reply about the process. It’s probably easier to learn if you think ‘gosh, I cocked this one up’, rather than having the stress of a formal complaint IMO.

Yes, complain. Nothing improves without it.

If you're not happy with the care you received it's fine to write in. I think unless you're also a GP who could oversee your notes/initial presentation then it's unlikely to realistically understand how ?inappropriate their treatment and diagnosis plan was. I do wonder if it's possible there's been a misunderstanding - sometimes initially it's more of a working impression then diagnosis - I'm concerned it could be x and lets try this treatment and gauge your response... Of course they could just have missed a lichen sclerosis before/late diagnosis and there over cautious about it.

I do note in the nice guidance which gives uk clinicians the current best practice guidelines that in terms of lichen sclerosis that it can be diagnosed by your initial symptoms/examination, and that investigative tests are not a 'must do'.

"Investigation - Diagnosis is often clinical and further investigation may not be necessary. See the section on investigation for tests which may be relevant."

My husband died because his GP diagnosed him with piles, when he actually had bowel cancer.

Works both ways.

@saraclara How awful for your poor DH and your family. I imagine lots of things went wrong in his care. I hope you had some answers.

It's just such a difficult work environment, especially so at the moment. Waits for procedures and tests are through the roof.
Just on the excess waits for hospital admissions currently estimated that an extra 250 people are dying each week because of the delay that wouldn't have otherwise died. 250 a week!!! Imagine how many are dying every week because of delays in testing and diagnosis.... Special tests for serious illness just not being available when years ago they could be routinely accessed for patients.

https://www.bbc.co.uk/news/health-68707883

Sorry I didn't mean for that to post twice, not sure how that happened!!

I mean it’s only LS so YABU to complain. Ordinarily most people would treat with the topical steroid and if symptoms didn’t improve go back to GP and likely get a referral to a gynae. Not life changing. Most docs treat LS as they would psoriasis (not a big deal).

Different if they had a skin growth and the gp said it’s not a concern and turned out to be cancer.

I think saying it’s only LS is a bit unfair, OP has now worried a lot about it. It’s not run of the mill for her.

Re treating friends and family, I don’t know if you’re in the UK, OP, this is not encouraged at all. Though human nature to ask opinion in the family.

Yes, I'm in the UK. My cousin doesn't ever treat me, I only ever ask her for second opinions (within her specialties dermatology or pediatrics)

LS is mostly diagnosed via a physical examination and a biopsy is far from routine so that isn't really an issue.
A 12 week course of a topical steroid isn't going to cause any permanent skin damage so you weren't really in any danger of that. I mean, you knew you'd have to go back if you wanted more cream, right? And you'd expect a review at that time, surely?

It's just as likely that the Dermovate, which is used for a number of skin conditions, cleared up your skin to the point that you do not need to use it anymore. So it quite possibly did what it is supposed to do, quickly and completely.

That's not to say I think you shouldn't say something if it's going to make you feel better but a complaint, when there was no harm done, probably isn't the way to go about it. It could just as easily be argued that the treatment was effective and there was never any danger of long term or permanent damage. You'd be better off going down a path of 'feedback' than a straight up complaint.

See this is the mentality now. You must be grateful that a mistake which could have had such serious consequences didn't happen. If op did not question this and just went ahead then she would have suffered. I would lay a complaint and expect a procedure to be followed.

Exactly! And I do not think the medical field is one where there should be much leniency given.
You're seen as difficult if you question a gp, but at the same time trust them completely.
It boggles my mind why GP's are the first point of entry for anything.

But why are they the gatekeepers to anything further? Why do you need them for a referral if they just know a little on lots of topics.

Even private insurance has you see GP first (whether NHS or private GP) and don’t accept direct client referrals. I think there are a few exceptions (eg physio). You don’t really want a 12 month wait to see an ENT at a hospital miles away for an ear infection etc.

Also for elderly and complex patients I think you’d find it difficult to have overall responsibility and pull all the different strands together and so on.

Going from weeping and bleeding to completely recovered in 48 hours is pretty miraculous. Did you use any of the steroid cream? How do you know it is definitely just dry skin? I wouldn't expect just dry skin to be weeping and bleeding?

I woupd write a letter explaining that your condition cleared up quickly and you think perhaps the diagnosis was wrong and you would like them to be informed of thos and to ensure they don't cause distress to others in the future. Inwould perhaps stop short fo calling it a complaint unless you have definitive proof it is not lichen sclerosis as it may have been the very end of a flate up and it could flare again so maybe exercise caution unless you have had a biopsy that proves the doctor was wrong

Yes, I used the steroid 3 times at that point. All of my symptoms I know I caused them, and if I didn't, I definitely made them SUBSTANTIALLY worse as I definitely scratched it more than once out of "pleasure".