GPs are being alerted to the danger of failing to diagnose an uncommon condition that can lead to blindness. In the latest edition of the MDU Journal, ophthalmologist and MDU Board member Mr Paul Riordan-Eva, examines where difficulties can arise in diagnosing giant cell arteritis (GCA), which most GPs will only encounter in one or two patients during their careers.*

Around three per cent of cases notified to the MDU by GPs relate to ophthalmic conditions and over a recent five-year period the MDU settled 51 claims arising from ophthalmology in primary care. Cases arising from GCA were responsible for the largest value settlements, even though the condition was the second most common cause of claims - the commonest being delayed diagnosis of retinal detachment. Compensation payments for ophthalmic claims ranged from £90,000 to £700,000. The reason for the large awards is mainly because GCA can rapidly result in severe visual impairment in both eyes if not treated promptly.

Mr Riordan-Eva commented:

"GCA is uncommonly seen in primary care, but by being aware of some typical features GPs can make an early diagnosis and patients may avoid loss of vision or even blindness. Symptoms to look out for include severe headache, scalp tenderness, or jaw pain in patients over 50, especially in the setting of sudden loss of vision. Confirmation of the diagnosis by superficial temporal artery biopsy requires hospital referral, but this is not the first priority. If GPs suspect GCA it is crucial to start, or arrange emergency hospital referral for treatment with high-dose systemic steroids, which usually will prevent further loss of vision. In general, it is preferable that some patients receive a short course of treatment unnecessarily than others suffer loss of vision due to delay in treatment."

The article provides GPs with a number of learning points, aimed at avoiding delays in diagnosing this potentially debilitating condition. It also examines a fictitious claim, based on actual cases handled by the MDU, where a 75-year-old woman became severely visually impaired after a delay in diagnosis of GCA by three GPs and two hospital doctors. The case was settled jointly by the MDU on behalf of the GPs and the hospital on the basis that there had been unreasonable delay in diagnosis and institution of treatment by both the GPs and the hospital.

In a separate article, Dr Karen Roberts, MDU medico-legal adviser, analyses some of the many calls the MDU receives from members on the subject of confidentiality.** The article looks at just over 200 such calls received over a recent two-week period with the commonest reasons for calls being:

- Children - 35 callers had concerns about whether to disclose information about children, for example to estranged fathers wanting access to their child's records.

- Deceased patients - 30 callers had questions about whether to breach confidentiality following a patient's death, such as when a will is disputed.

- Police requests - 28 members had questions about disclosing information to the police, such as in connection with allegations of crimes committed by a patient.

- Patient access to records - 21 members needed advice following patients' requests for information about their own records which, for example, the doctor felt might cause distress to the patient.

References

* An insight into ophthalmic claims, Mr Paul Riordan Eva, MDU Journal, Volume 23 Issue 2, December 2007 pp 20-21

** Ring of confidence, Dr Karen Roberts, MDU Journal, Volume 23, Issue 2, December 2007 pp 6-9

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