GP Failed To Advise Me About Cauda Equina Symptoms
Cauda equina syndrome is rarely encountered by a GP. It might be once, or even not at all, in a whole professional career. In contrast, back pain is very common indeed, and back pain with unilateral sciatica is regularly seen in primary care.
For a patient with severe back pain and sciatica, all competent GPs would take a history to confirm the problem was in fact limited to back pain and left sciatica, and would perform a neurological examination to check reflexes and power, and to confirm there was no significant sensory loss.
If there are signs of neurological dysfunction, a GP should immediately refer the patient to hospital for suspected cauda equina syndrome. A same-day orthopaedic assessment is required. If a GP does not recognise or act on cauda equina syndrome symptoms or signs, there will be a breach of duty.
GP did not advise about red flag symptoms of cauda equina syndrome
But if a patient is not displaying signs of cauda equina syndrome, it is reasonable prescribe painkillers and monitor the condition.
However, cauda equina syndrome is a progressive condition and the patient may develop further symptoms at a later stage. It is important the patient is made aware of these symptoms, or he/she will not know that immediate medical attention is needed.
Typical GP publications do not suggest that every patient with back pain and unilateral sciatica should be warned about the possibility of cauda equina syndrome. Nevertheless, the NHS clinical summary does currently suggest that a GP should “give advice on if and when follow up is needed, and red flag symptoms and signs that may require urgent reassessment.”
Therefore a patient should be told to watch out for the development of certain symptoms. The patient should also be told that if these symptoms do arise, immediate medical help should be sought.
Red flag symptoms of cauda equina syndrome
These symptoms are known collectively as the red flag symptoms of cauda equina syndrome and include:
- Pain in both legs (bilateral sciatica)
- Numbness in the genitals, perineum, buttocks and legs
- Leg weakness
- Urinary dysfunction
- Bowel dysfunction
Giving advice about warning signs of cauda equina syndrome is not something that can be adequately explained in a minute or two. It requires explanation that nerve root compression affecting the leg can progress to affect the nerves affecting bladder, bowel and sexual function, as well as skin sensation in the genital/anal area. It then requires a description of the way in which each of these problems can present and advice to seek urgent consultation if they should occur.
If a GP fails to advise a patient about the red flag symptoms of cauda equina syndrome, causing their diagnosis and treatment to be delayed, there will be a breach of duty.
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If GPs did not provide a reasonable standard of care during the diagnosis and treatment of your cauda equina syndrome, you could be eligible to claim compensation. Contact us for more information.
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