A GP practice in the Hertfordshire area

4. Mrs G complains the Practice failed to identify signs of a heart attack and to take the right action when her husband went to it in July and August 2022.

5. Mrs G says her husband would not have died if the Practice had done more. She told us her husband’s death meant she had to stop working and this has affected her financially. She also says she needed bereavement counselling.

6. Mrs G would like to make sure this does not happen to others. She would also like a financial payment.

7. In July 2022, Mr G went to the Practice to discuss three issues - his loose stools (diarrhoea), a testicular lump and chest pain symptoms. Mrs G says the Practice failed to treat the chest pain.

8. Mrs G says the Practice denies that Mr G mentioned his chest pain at the appointment.

9. Mrs G told us that in early August Mr G had a phone appointment with the Practice after it called him to discuss some recent test results.

10. Mrs G says the Practice gave incorrect medical advice to her husband during this call which contributed to his avoidable death. Mrs G says the Practice failed to refer him for cardiology (heart) tests. She says the Practice misdiagnosed chest pain symptoms as panic attacks and gave advice for Mr G to learn how to control his breathing, stay calm and manage his anxiety.

11. She explains the Practice told her husband that if the pain went down his arm, this would be a heart attack symptom. She says Mr G felt reassured by this as he had no pains in his arms, just a feeling of anxiety and chest pains.

12. Mrs G feels the Practice failed to consider his medical history and left Mr G with a wrong diagnosis and false reassurance.

13. The Practice arranged a follow up appointment with Mr G a week later but sadly Mr G died before this.

14. Mrs G believes that if the Practice had given the correct advice to her husband about what to look out for, he would have called 999 and may still be here today.

18. Before we decide if we should do a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any signs that something has gone wrong. We looked at each appointment to see if what happened was in line with the relevant guidance.

19. Mrs G’s main complaint is that the Practice missed an opportunity to diagnose signs of a near heart attack.

20. Mr G’s medical records show he went to the Practice on 21 July 2022. It is clear Mrs G disagrees with what the records say about this appointment and what was discussed. Mrs G describes her husband as experiencing chest pain and says he would have discussed this at the time. We do not doubt what Mrs G tells us.

21. The records show the Practice looked at Mr G’s history. He discussed a lump in his testicle and having irregular bowel movements. The Practice examined and referred Mr G for more investigations. The records do not mention that Mr G discussed chest pain. Our adviser said there was no evidence in the records to suggest the Practice failed to identify signs of Mr G’s coming heart attack.

22. Based on the medical records, the Practice appropriately considered Mr G’s medical history and assessed his symptoms in line with GMC guidance, which says doctors must give a good standard of practice and care when assessing a patient’s condition.

23. We recognise there is a difference between Mrs G’s account of what happened during the appointment and the Practice’s. It is difficult for us to be able to say exactly what happened as the available evidence is limited. Based on what we do have, we think it is more likely than not that Mr G did not report his chest pain symptoms during the appointment. We have reached this decision based on the quality of the medical record and what has been written. We recognise there is uncertainty about what was discussed. We thank Mrs G for the information she gave us and understand it would have been hard to describe difficult events. We accept Mr G was experiencing chest pain at this time, but we think if he did mention it, it would have been noted in his medical record.

24. Mr G’s medical record shows the Practice called him in early August to discuss recent blood test and testicular scan results. During this call, Mr G told the Practice about recent panic attacks. He said he experienced them when completing time-pressured tasks.

25. We can understand why Mrs G worries if the Practice did enough because Mr G sadly died four days later.

26. NICE chest pain guidance says people should be admitted to hospital when the patient’s condition suggests a serious chest pain. For patients who do not need to go to hospital, they should be referred for urgent same-day assessments if they have suspected acute coronary syndrome (ACS is when different conditions suddenly stop or disrupt blood flow to the heart) and are pain-free with:

• ‘Chest pain in the last 12 hours and a normal ECG (electrocardiogram) and no complications (such as pulmonary oedema).

• Chest pain in the last 12–72 hours and no complications.’

27. The guidance says ACS should be suspected when certain symptoms show. They include pain in the chest or other areas lasting longer than 15 minutes and associated nausea, vomiting, sweating or breathlessness. There are other factors listed in the guidance, all of which were not described by Mr G in the consultation record. Because of this, the Practice had no reason to suspect Mr G had ACS.

28. The records show the Practice took Mr G’s history, which included chest tightness and hyperventilating (irregular breathing) which resolved when he relaxed. Our adviser said the Practice asked about cardiac symptoms, including crushing chest pain and shortness of breath, which Mr G said he did not have. Our adviser said while Mr G was a middle-aged man and there was a risk of coronary artery disease, there was no suggestion that Mr G needed immediate referral to hospital. There was nothing in the records to suggest Mr G’s health would decline so quickly.

29. Our adviser said symptoms of coronary artery disease are similar to those of anxiety, which can be mild, and it may well be that Mr G was experiencing panic attacks at the time.

30. The medical records show another appointment was scheduled for a few days later to assess Mr G in person. Our adviser says based on all the available evidence it is unlikely that any other intervention, other than an immediate hospital referral, would have saved Mr G. For reasons we have already explained, this was not seen as necessary at the time. Our adviser says the Practice gave the right advice to contact urgent care if needed. Our adviser confirms there is nothing in the records to suggest signs of a coming heart attack, or that further urgent investigations were needed.

31. We hope this gives Mrs G some reassurance. For these reasons, we do not think the Practice failed to do anything to prevent Mr G’s sad death. We recognise that Mrs G continues to be deeply affected by what happened. We are very grateful to her for sharing this experience with us.

1. We have carefully considered Mrs G’s complaint about the way a GP practice in the Hertfordshire area (the Practice) cared for her husband, Mr G, who sadly died in August 2022. We are very sorry for her loss.

2. We have decided not to look at this complaint further because we have not seen any sign that the Practice did anything seriously wrong.

3. We know how important this complaint is to Mrs G and how much these events have affected her. We thank her for the details she kindly shared with us.