Health Ombudsman Complaint - part 3

Part 3 of my complaint about my complaint to the health ombudsman!… I have listed only a couple of the summary points at a time, so I can include my comments about them in the same blog post.

This one is mostly on the 2 appointments I had with Dr Vo - when I asked for a referral to a neurologist and did not feel at all listened to, plus how the Doctors can write they did ‘neurological exams’ when they only did a part test.

3) I do not believe Dr Vo gave a true representation of my symptoms, on either of the dates I saw her, on my medical notes and have major concerns in her ability.

4) I have concern that the doctors at Giggs Hill were not following the guidelines for full ‘neurological exams’.

Point 3: On my medical notes on 9th March 2016 from Dr Vo it states that I had ‘no headaches’ which is not the case.

I do remember saying to her that “I never normally have headaches, but that I had been getting an increasing number of dull pains in my head and also head pains and pounding.” Which was significant and new for me. But I recall she asked this while she was sitting at her desk facing away from me and not looking in my direction at all.

To back my case - I had contacted a practitioner in December as I had been getting a dull ache at the bump at the centre back of my skull, and also been seeing, at various times since, a craniosacral therapist, Bowen practitioner, homeopath and osteopath because of these pains and dizziness. 

As well as the physiotherapist I had been referred to via Dr Brodie and had seen twice by the first time I saw Dr Vo, so I know I had both sharp and dull head pains or headaches (if you prefer to call them that) when I saw her. Hence why

 I don’t know how she could write ‘no headaches’.

I also have a chart which I write down any major symptoms on, and from the 28th February I had added a new column where I specifically noted “head/neck pounding” – which means I had already been suffering with this for a while before I wrote it with the start of my new chart.

She also wrote on this date that I had ‘no neurology’ I assume by this she means the nose to finger test? Which after looking at how they should be done online I do not believe she even did correctly as the distance of her finger I felt was the same in all, when it should have been a different depth. 

I had NO heel to toe test done, so with a patient complaining of severe and constant dizziness/vertigo surely this should have been the most obvious neurological test?

Dr Vo also has it on the notes and told me it would be a 3-4 week wait for my x-ray report to come back, despite it showing as arriving back the next day on my notes. Hardly helpful when I was told by her to book a follow up appointment as I left her surgery allowing this length of waiting time, when I felt so awful.

I think in my appointments Dr Vo decided the focus would be neck pain as I had equal concerns with my dizziness as well as the neck pains and headaches. I had told her this- but she focused on the neck pain, saying 

we could only address one issue at a time.  

My husband again walked me into the consulting room supporting my balance- as he did with all the appointments (as I would have bounced off the walls otherwise). I was also clearly told at the start of one of the appointments ‘what was my main symptom?’- even though I had several, which all seemed to be linked. How was I to know which is most serious or relevant in which to tell her? 

At the last count my body is still connected- so why she could only focus on one issue at a time, and not a symptom cluster I have no idea?

I feel my dizziness got ignored over the neck symptoms. If she had counted everything she may have seen a different picture?

On the final Glenlyn reply letter dated 30 January 2017, it says Dr Vo was acting re the specialists suggestion (ENT) when she offered me painkillers – yet the letter from Dr Wilson states that:

 “if her symptoms are ongoing particularly related to her neck then it may be worth pursuing a Neck Specialist Opinion”.  

Surely Dr Vo should have referred me for this if she was ‘doing as suggested’?

On the complaint reply letter from Glenlyn- point 3 states why I asked for a neurologist and on the ENT letter it suggested a ‘neck specialist’. This was as when I went to the ENT appointment, Dr Wilson spoke with a colleague as to my next best course of action and then told me they most likely thought my issues would be from my neck, but to definitely get to see another specialist- either a rheumatologist, osteosurgeon or neurology/neurosurgeon- which ever was best for neck/nerve pain in the area that I live. Surely a ‘neck specialist’ could be all of these?

This letter also states I should have got another appointment within a week if things were continuing, yet it took 2-5 weeks to get a routine appointment. Maybe Dr Vo didn’t realise how bad the appointment waits were at her own surgery?

Dr Vo also made it very clear as I left the emergency appointment that these appointments I was not to use again unless it was an acute emergency- which ongoing dizziness and pains were not. Also that she was not able to advise us in them if I could claim any type of sickness benefit etc -as I was unable to even look after the house let alone do anything apart from sit on the sofa. In fact 

I felt she took more time up telling me why I was wrong and what she couldn’t do then she did listening to and helping me.

It also says “she was reassured by both the ENT specialists opinion as well as the x-ray findings and normal neurological examination”- but surely this should be the opposite and she be even more concerned that none of these tests had found an answer to the cause of my symptoms? And in fact it be more of a reason to refer me to a specialist? (be it neck or neurology)

As I put in my previous letter “Both my husband and I felt that my symptoms and concerns were not treated with respect by Dr Vo, and that it felt she was all but saying I was exaggerating them or being a hypochondriac.

At no point in either of the two appointments with her did I feel listened to and that she was asking questions. I did not feel as though she understood how seriously it was effecting every part of my life. I kept trying to say to her various things that were happening to me in the hope it would make her connect the dots on something and diagnose me, but felt I was just being annoying and that she was not listening.

Also these points were raised on my last letter relating to on your link from:

http://www.gmc-uk.org/guidance/good_medical_practice/apply_knowledge.asp  (although the actual web page you gave me no longer exists) I have copied the comments I disagree with in blue.

14. You must recognise and work within the limits of your competence. So surely a GP should refer me to a neurologist rather than insist in take pain killers or insist I have an x-ray when I was showing progressive, sub‑acute loss of central neurological function?

15. You must provide a good standard of practice and care. If you assess, diagnose or treat patients, you must:

a. adequately assess the patient’s conditions, taking account of their history (including the symptoms and psychological, spiritual, social and cultural factors), their views and values; where necessary, examine the patient

I assume this does not include tutting and rolling your eyes at a patient when they say they don’t take pain killers? – as Dr Vo did to me and was witnessed by my husband.

Dr Vo and Dr Milne also did not examine me with the heel to toe test at all during the appointments. (only Dr Brodie and the private doctor did this)

b. promptly provide or arrange suitable advice, investigations or treatment where necessary. So why didn’t I get referred, even when I asked for a neurological referral?

c. refer a patient to another practitioner when this serves the patient’s needs. This did not happen.

16. In providing clinical care you must:

a. prescribe drugs or treatment, including repeat prescriptions, only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment serve the patient’s needs.

So why did Dr Vo want to prescribe me diazepam? How did she know this would serve my needs, when she had seen me all of 5 minutes, I had none of the main conditions for prescribing it, and was already having the possible side effects as issues? If I had agreed to diazepam there would have been the very real possibility I would have had a stroke or died while spaced out on my sofa!

b. provide effective treatments based on the best available evidence. I did not see this. I believe if a layperson can find the evidence that I needed an urgent scan, a fully qualified Dr should be able to.

c. take all possible steps to alleviate pain and distress whether or not a cure may be possible I totally disagree that this happened. I was given further distress by being refused referral, felt I was not listened to and even ridiculed, even thought my symptoms were going rapidly downwards.

e. respect the patient’s right to seek a second opinion Although as I could not get any referral on request- we had to pay for a private Dr’s opinion.

If you supposedly read and took into account these comments on my previous letter, then 
please tell me how you know that Dr Vo followed all guidelines correctly if you were not there? 

I was there and I left the room in tears as I felt so disgusted and not listened to. She did not seem interested in wanting to help me, and for much of the appointments seemed more interested in writing notes at her desk than even looking at me. I felt she had no respect for my opinion on what drugs I wanted to take – or not, and didn’t seem to care one bit that I could barely do more than sit on my sofa feeling worse each day.  My husband was also there, his opinion was that she just wanted to write a prescription and get us out of the room as soon as possible.

I would also like to know what Glenlyn has written in their Significant Event Analysis meeting about Dr Vo (I am still awaiting this information) as regarding Dr Brodie’s actions it says they were “considered appropriate” at this meeting. What about Dr Vo’s?

Regarding point 4:

I do not believe that I was given a full neurological exam at any point after January 2016 at Giggs Hill, (apart from with Dr Brodie in January) It clearly says on www.gpnotebook.co.uk/simplepage.cfm?ID=x20040509161757089560 that these following 3-minute neurological examination has been designed by neurologists to exclude sinister causes of headache including brain tumour and haemorrhage.

Yet I am 100% sure neither Dr Vo or Milne asked me to do the heel to toe test or walking on heels- both which I KNOW I would have failed.  I walked in being held by my husband- how can they not have tested me for this?

I remember doing some eye tests and possibly facial ones, but even when I did most of these when I was admitted to St Georges their only ‘hard cerebellar sign’ noted was ‘inability to do heel to toe walking’. So surely if this was the ONLY test I failed despite having swelling in the brain and hydrocephalus - why weren’t they done with a patient complaining of dizziness by the GPs?