Don't blame the receptionist - Medical case study

Medical case study

Background

Mrs H phoned her GP practice requesting a home visit for her husband (age 41) who was complaining of sudden onset of chest pain and vomiting. Mr H was previously very fit and even had a personal fitness trainer. A locum, Dr P, attended but did not take the patient’s notes on the home visit. He diagnosed gastritis. Two days later Mr H died suddenly at home. Post mortem revealed the cause of death as a haemopericardium from a ruptured myocardial infarction.

Analysis and outcome

The pathologist commented that the history given to the practice receptionist was that of a classical MI and that there was a family history of cardiac problems recorded in the patient’s notes which would have been seen by Dr P had he brought them along. The locum later admitted that if he had been aware of the family history he would have admitted Mr H to hospital. It also transpired that the receptionist was very careful to note full details of the story given by Mrs H. She recorded that there was radiation to both arms from the chest pain, and that she had referred the call directly to the locum when the fact about the radiation was made. Dr P denied this – however the call sheet showed that the receptionist’s version was correct. The case was settled for £350,000.

Key points

• With advances in immediate and life saving treatment for ischaemic heart disease, all chest pain with any suspicious additional features should be referred to hospital.

• History taking should be used to gather as much relevant information as possible.

• All such requests for house calls should be clearly recorded and drawn to a doctor’s attention.