Howard*, then aged 48, attended the GP surgery concerned about blood in his stool and changes to his bowel habit. He was seen by a trainee doctor under the supervision of another GP at the practice. The trainee performed a digital rectal examination and reassured Howard that there was no abnormality, advising that his symptoms were likely caused by stress and that there was nothing to worry about unless he unexpectedly lost weight.
Howard made lifestyle changes to reduce his stress, trying different diets and exercise but had increasing symptoms of urgency. Eventually, his symptoms were so severe that even after he had opened his bowels, he felt the need to go again ('tenesmus').
Howard returned to his GP surgery and was seen by a different trainee doctor who performed another digital rectal examination. He reiterated that his symptoms were probably due to stress and repeated the advice to return only if he started to lose weight. He prescribed laxatives and advised Howard to consider self-help books for stress. Howard re-attended the surgery several months later, and despite a fourth GP reassuring him, he insisted on a hospital referral.
A 7cm tumour in the low rectum was diagnosed following a referral for colonoscopy nearly 18 months after his initial visit to his GP surgery. Biopsies confirmed an invasive moderately differentiated adenocarcinoma.
Following radiotherapy and chemotherapy, Howard underwent surgery to remove the tumour. Unfortunately, because of the delay in referring him for colonoscopy, the cancer had spread to his liver and Howard required liver resection. His prognosis is worse than it would have been had been diagnosed shortly after his first visit to the GP.
Lindsay alleged on Howard's behalf that he presented with clear signs of bowel cancer which the GPs failed to act on. It was alleged that but for the delay Howard would not have developed liver metastases and his long-term prospects would not have been affected. While the doctors who had seen Howard in the months just before his diagnosis had clearly missed the rectal tumour, which would have been evident on proper examination, by that time the cancer had already spread. The focus of the allegations was therefore on the first treating doctor and his supervisor, who had failed to ensure that the trainee had made a diagnosis or arranged a referral.
Comprehensive evidence from numerous experts was obtained. Following joint expert discussions, a lengthy meeting to try to settle the case without going to trial took place and the parties reached settlement.
* name changed
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