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MDO warns GPs about spinal nerve condition after paying claims worth £12.5m

GPs have been warned over the importance of promptly diagnosing a spinal nerve condition by a medical indemnity organisation after it paid out more than £12m to patients suffering long term disability.

The Medical Defence Union paid out £8m in compensation and £4.5m in legal fees to settle claims for alleged failure to diagnose cauda equine syndrome, a condition which causes compression to nerve roots below the end of the spinal cord.

Dr Grace Cheung, MDU claims handler said: ‘This is a difficult condition to diagnose in its earliest stages, as symptoms of lower back pain are very common,

'Unfortunately, a failure to quickly refer a patient with cauda equine syndrome can have very serious consequences for them, including paralysis, incontinence and impaired mobility. It’s important for GPs to be aware of potential symptoms to avoid delays in diagnosis.’

The majority of the 150 claims between January 2005 and August 2016 involved GPs, some working out of hours.

The MDU advised GPs to use their clinical judgement and consider factors to try and avoid delays in diagnosis of the condition.

  • Conduct a full examination of the patient to establish the likely cause of the back pain and make a record that this has been done.
  • Consider whether there are any red flags such as pain radiating below the knee bilaterally, lower limb numbness/weakness, numbness on either side of the buttocks and saddle area, bladder or bowel disturbance or erectile dysfunction.
  • If symptoms are present, call the hospital orthopaedic or neurosurgical specialist for immediate advice, or if they are not available, arrange for the patient to be admitted to hospital via the emergency department.
  • Give patients diagnosed as having back pain appropriate safety netting advice, including advising the patient of what symptoms to look out for and the importance of seeking urgent medical attention if these appear.
  • Make a record in the notes to demonstrate you have actively considered the condition and provided safety netting advice.

The MDU warned that claims for alleged delayed diagnosis in cauda equine syndrome could be made for large amounts of money if the patient can no longer work but was a high earner with many years of employment ahead of them.


Readers' comments (15)

  • Dear All,
    "£8m in compensation and £4.5m in legal fees".

    Sort of hints at the problem what?
    Paul C

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  • This has always been near the top of successful claims against GPs working Out of Hours. It is not enough to put "No red flags" in the notes. It is preventable, but catastrophic if it happens and lawyers will go for the first doctor who might have been able to prevent it happening.

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  • Knowledge is Porridge

    And people wonder why we can't recruit gp's.

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  • Isn't this along with whiplash one of the great legal scams of out times? The reality is that diagnosis is difficult, access to scanning is difficult and establishing time of onset retrospectively is difficult yet somehow the layers have once again pulled a fast one. There is an ongoing debate about the implications of the time taken to operate and its effect on prognosis but despite the lack of high quality evidence, lawyers have yet again established opinions as fact. This condition would be perfect for a statutory compensation system.

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  • GP is becoming too risky. The fact that risk taking in primary care keeps the nhs from sinking is a concept that is not understood. Backache = MRI scan cannot be afforded by nhs so something will have to give.

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  • In Medway GPs aren't allowed to refer for MRI scans for a month now. Referred a malignancy patient with severe low back pain to the local assessment service so they could order one. Mind you, the hospital has just come out of special measures, time to put primary care or the CCGs themselves under these measures.

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  • Cobblers

    Cauda Equina is high up in the medicolegal costs? Who'd have thunk it?

    It's one of those easy as pie diagnoses or harder than Hades diagnoses. Like early sepsis.

    We need to rethink GP indemnity. Now.

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  • Dear Pulse
    Your lack of ability to spell the name of this condition does not give confidence in anything you might have to say about it. And any GP who needs it defining should not be working as a GP.

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  • Dear Deborah @ 2.13pm,
    Should a sentence begin with "And"?

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  • Mavis 2:48pm
    Love it!!!!

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