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Miss A developed a significant headache while at work which caused blurred vision and nausea.   Her symptoms were so bad that an ambulance was called and she was brought to hospital.   At the hospital her Neurological examination was essentially normal.  She  was observed when receiving intravenous fluid and analgesia.   After some hours she was assessed and though she still had the headache she was feeling somewhat better.   The blurred vision and dizziness had resolved.  Migraine headache was diagnosed and she was discharged.

Some two days later she still had bad headaches and attended her GP who listened to her history and read the hospital letter of discharge.   The GP noted that she still had a throbbing bi-temporal headache which was worse on movement and relieved when in a dark room.    He found Miss A to be worried that she would loose her job.   He explained to her that the likely cause of her headache was migraine precipitated by work stress.  He did have concerns, however, with the blurred vision and decided that an Ophthalmology Opinion and an MRI Scan would be useful to rule out vascular normality.   He recorded this in his notes.

Miss A continued to have headaches which varied in severity.    She hoped they would pass and didn’t seek further medical assistance.   A month later she lost consciousness and collapsed and died.   A scan confirmed a large subarachnoid hemorrhage.   A Claim was brought against her GP for alleged delay in referring Miss A for an Ophthalmology Opinion and MRI Scan as the GP had indicated he would.   Clearly the Doctor had considered the possibility of a vascular anomaly and arranged a further investigation.   It is was further claimed that his diagnosis of migraine was unreasonable given her age and her mix of symptoms.   A claim was also made against the hospital.

The Claim was settled.   It was concluded that the patient’s presentation to the GP was so suggestive of a subarachnoid hemorrhage that hospital admission was essential that day to exclude a diagnosis.   The Doctor had reasonably considered a vascular event as a cause of the headache, however, he erred in planning to wait and arrange an MRI Scan if the headache didn’t settle.     It was concluded that it was not reasonable to wait before arranging the referral.   This case emphasises the importance placed on a Medical Profession being prepared to revisit a colleagues diagnosis particularly if a patients condition has changed.   In this case the GP was mislead by the diagnosis made at the Hospital where the necessary investigations had not taken place.   On the day Miss A presented to the GP he was obliged to act on what he was actually seen and was, perhaps, too quick to attribute Miss A’s symptoms as stress at work without excluding any serious physical causes first.


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