A GP saw a patient who had a firm smooth swelling on the proximal phalanx of her thumb, close to a scar from an old injury. It was not tender and the GP thought that it was probably a ganglion. However, he requested an x-ray of the thumb to be sure that it was not a bony swelling. The x-ray showed mild changes of osteoarthritis.
The patient returned the following month to discuss the x-ray results. The doctor explained the findings and suggested that they may well confirm that the swelling was a ganglion. He advised the patient that this could be removed by surgery but she was not keen. The doctor asked her to come back if she changed her mind or if the lump became tender.
When the lump became larger and painful a few weeks later, the patient returned to her GP and asked to be referred.
The orthopaedic consultant initially diagnosed the lump as a benign giant cell tumour of the tendon sheath, but it was found to be a spindle cell sarcoma on excision biopsy. However, the resection margins were not clear of tumour and the thumb was amputated.
A claim was received alleging negligent failure to refer the patient to hospital urgently when she came in to discuss the x-ray results.
At the time of referral there was no indication that this was a malignant lesion. The short delay made no different to the treatment or prognosis
The MDU obtained a report from an independent GP expert. The expert considered that the referral was appropriate and complied with NICE guidelines. He did not think that there had been any indication for an urgent referral. The MDU obtained a report from an orthopaedic oncologist. He advised that amputation of the thumb would always have been the appropriate treatment for this type and site of tumour.
It is not uncommon to receive claims which relate to very rare tumours which present as common conditions, as in this case. Our expert evidence supported the fact that the GP made a reasonable diagnosis and gave appropriate advice. The patient followed this advice, returning to her GP when the lump grew larger. At the time of referral there was no indication that this was a malignant lesion. The short delay made no difference to the treatment or prognosis.
Liability was denied on behalf of our member and a firm response was sent, outlining our expert evidence. The claim was discontinued.