A practice in the Wandsworth area

3. Mr G complains that Miss O of the Practice failed to diagnose his spontaneous pneumothorax. This is where air enters a space between the lung and membrane around the lung without known cause, leading to partial or complete lung collapse.

4. Mr G said he could have lost his life due to the missed diagnosis. This has caused Mr G significant distress. Mr G said this failing has also caused a disruption to his life, such as having to miss work, miss his holiday, and he had to pay for extra insurance fees as he needed treatment whilst abroad.

5. As an outcome, Mr G wants service improvements, financial reimbursement for the insurance fees he had to pay, and Severity of Injustice scale level 2 financial remedy (£120-£550).

6. Mr G had symptoms in June 2024, saying late in the evening, he felt like he had something in his chest and still felt like this when he went to bed. Mr G said the next morning on the way to his office, he could not walk because of serious chest pain and a bad cough. Because of his symptoms, Mr G went home and got a consultation at the Practice.

7. Mr G attended a consultation with Miss O at the Practice, presenting with symptoms including rib pain, flu-like symptoms, and a persistent cough. Mr G confirmed Miss O diagnosed him with costochondritis without further diagnostic tests and advised over the counter pain relief for symptom management.

8. Mr G then flew to Spain for an annual CT scan which he had later in June 2024. Mr G has told us that due to a condition he has, he receives an annual CT scan in Spain.

9. Mr G flew back to the UK. Shortly after returning to the UK, Mr G received an urgent call from his doctor concerning his CT scan, telling him that he had pneumothorax and it could get worse. Mr G said he then went to A&E where he had an X-ray, and his pneumothorax was confirmed.

10. Following his diagnosis Mr G saw a private respiratory physician twice in June who advised that he was now safe to travel by air and that he could restart normal exercises.

11. Mr G flew back to Spain and had a further clinical review. During this he was told he should not have flown and that flying was dangerous with his condition. The Spanish clinician advised surgery. Mr G sought a second opinion and decided to have surgery, which took place in July 2024.

15. Before we decide if we should conduct 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 found any signs that something has gone seriously wrong.

16. Mr G specifically complains that Miss O misdiagnosed his spontaneous pneumothorax. Mr G says that Miss O should have referred him for an X-ray with the symptoms he presented with in June 2024.

17. GMC guidance say doctors should adequately assess a patient’s condition.

18. Mr G’s medical records show, he presented with two problems, right sided rib pain and a cough.

19. NICE guidance says the symptoms of pneumothorax include sudden-onset pleuritic pain (a sharp, stabbing pain in the chest) and breathlessness in people with or without pallor (decreased blood flow to tissues) and tachycardia (a heart rate over 100 beats a minute).

20. It also explains the signs of pneumothorax include: • reduced chest wall movements • reduced breath sounds • reduced vocal fremitus (the sound the lungs make when speaking) • and increased resonance of the percussion note on the affected side.

21. Mr G’s medical records show that Miss O assessed his heart rate, which was 88 beats per minute and not indicative of tachycardia. They noted his chest had good air entry, normal oxygen levels and no added sounds and no wheeze. When considering the guidance, and the findings of the assessment, we have not seen any signs Miss O missed symptoms of a pneumothorax.

22. Our adviser confirmed this was the information given to Mr G about what to look out for (sudden chest pain, with chest tightness, shortness of breath, sweating, radiating to jaw or arm, and nausea). They also explained where to go if those things happened (safety netting advice) was appropriate and what you would normally expect to see.

23. We asked our adviser if the assessment was in keeping with what they would expect to see given Mr G’s presenting complaint and they confirmed it was. They also confirmed Mr G did not present with any symptoms that would require an urgent A&E visit or an X-ray.

24. In summary, we are satisfied the Practice acted in line with GMC guidance in adequately assessing Mr G’s presenting symptoms. For this reason, we have seen no signs anything was seriously wrong with the Practice’s assessment.

25. We are very sorry to hear about what happened after the assessment. We hope our decision provides Mr G with assurance about his care and helps bring this matter to a close for him.

1. We are sorry to hear about the very distressing time Mr G has clearly experienced as a result of his delayed diagnosis. We would like to thank Mr G for sharing the details of his concerns.

2. We have carefully considered Mr G’s complaint about the Practice. Having done so, we have decided not to investigate this complaint further. This is because based on the evidence available to us, we have not seen anything went seriously wrong in the Practice’s consultation with him in June 2024.