Painful elbow - medical case study

...Mr D complains that he had not been warned of the risks associated with the procedure...

BACKGROUND: Mr D is a keen golfer and attends his local GP surgery complaining of a very painful elbow with limited movement. He is seen by one of the senior partners – Dr L – who makes a diagnosis of epicondylitis. Dr L discusses treatment options with the patient and, given the severity of the pain, recommends a steroid injection. This is administered to the painful area with an anaesthetic.

Two months later Mr D re-attends the surgery with “dimpling” and texture changes of the skin around the injection site. Dr L explains to the patient that this is caused by loss of fatty tissue (atrophy) and is a recognised complication of soft tissue steroid injection.

Six months later the surgery receives a formal letter of complaint from Mr D in regard to Dr L’s “substandard” treatment. He states that in the weeks and months after the injection he has experienced pain and discomfort, and that the skin over the injection site has “shrunk” and grown discoloured.

Mr D also complains that he had not been warned of the risks associated with the procedure.

ANALYSIS/OUTCOME: MDDUS provides Dr L with advice on his response to the complaint. In the letter the GP expresses his sincere concern and regret for the complication. He states that he has performed many such procedures in the past and has never had a patient suffer steroid-associated fat atrophy. His understanding was that this complication was most commonly related to superficial injections and that he was confident his standard technique avoided the possibility. For this reason he did not routinely inform patients of the risk of fat loss.

In closing Dr L again offers an apology for the incident and states in future he will inform patients undergoing steroid injections of the full risks attendant to the procedure. He also informs the patient of his right to take the complaint to the local ombudsman if dissatisfied with this response and provides contact details.

Mr D later emails the surgery to say he is satisfied with Dr L’s response and will not be pursuing the matter further.

KEY POINTS

  • Ensure that relevant risk factors are part of routine consenting for procedures.
  • Often a sincere apology is enough to prevent a complaint escalating into a legal claim.
  • Note that steroid injection may not be the first treatment of choice in epicondylitis.