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Failure to diagnose hip fracture owing to inadequate physical examination (02HDC16966)

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(02HDC16966, 10 December 2003)

General practitioner ~ Standard of care ~ Physiotherapy ~ Hip fracture ~ Assessment and examination ~ Specialist referral ~ Record-keeping ~ Rights 4(1), 4(2)

Following a fall from a horse a 47-year-old woman visited a physiotherapist, who provided treatment and recommended that she see a doctor, as the injury would require time off work. The woman consulted her GP and stated that she was experiencing considerable pain and discomfort in her right leg and hip. The GP observed the woman's movement but did not undertake a physical examination. He prescribed a painkiller and an anti-inflammatory and told her to continue with physiotherapy. The woman consulted the GP on two further occasions and then sought a second opinion from another GP, who arranged an X-ray. The X-ray indicated a fractured neck of femur, and the woman was admitted to hospital for surgery.

The woman complained that her GP did not adequately assess her hip and did not consider a fracture injury, leading to a delay in her treatment and subsequent recuperation.

The GP's notes contained no evidence that a history of the injury or any previous injuries was obtained, or that a standard physical examination was carried out or the injury site viewed. It was held that the GP breached Rights 4(1) and 4(2) by failing to appropriately examine and diagnose the fractured hip on three occasions, or to refer the patient for an X-ray or to a specialist. The Commissioner's expert advisor indicated that the GP lacked knowledge in the area of hip fractures (in particular with regard to weight-bearing ability). At the first consultation the GP should have referred the patient for an X-ray to exclude bony injury, and when after two weeks there was little improvement, he should have considered referral to a specialist.

The GP accepted the Commissioner's findings and confirmed that he would undertake further medical education in relation to this type of fracture.


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