When a patient presents to a GP with the symptoms of cauda equina syndrome, an urgent referral to hospital is needed. A patient may not necessarily have cauda equina compression, but immediate investigations are needed to confirm or rule out a diagnosis.
Presenting to GP with symptoms of cauda equina compression
At first a patient will often experience lower back pain and sciatica. Further symptoms may then develop, including loss of sensation over the buttocks, anus and perineum, as well as difficulty urinating.
This is a history which, in the context of low back pain and sciatica, would cause all competent GPs to arrange same day orthopaedic assessment for a patient, because of the possibility of cauda equina syndrome.
GP examination for cauda equina syndrome
The question of examination almost become irrelevant, because a patient’s symptoms clearly suggest the need for specialist assessment. However, that is not to say an examination should not be performed by a GP.
Indeed, it is important to document a patient’s physical condition, and seeking objective corroboration for reported symptoms is part of standard medical practice. The examination should involve testing the loss of sensation, whether by light touch or pinprick.
The issue of whether a GP should also perform a digital rectal examination is debatable. This is for two main reasons. Firstly, most GPs will hardly ever have occasion to test anal tone as a discriminatory feature in diagnosing possible cauda equina syndrome.
Secondly, motor abnormalities generally follow sensory loss. Therefore sensory loss will be more of a distinguishing feature at this stage, and one that should encourage referral to hospital before the point of anal sphincter weakness is reached.
GP urgent referral to hospital for cauda equina syndrome
Having seen and assessed a patient, the GP should then contact the hospital and also give the patient a letter, outlining the reasons for the emergency referral. It is not enough simply to tell a patient to attend A&E. The GP must contact the hospital to arrange for the patient to be seen, or at the very least advise A&E that the patient will be attending.
To only tell a patient to go to A&E in such circumstances would be a rather unusual breach of professional etiquette. If a GP fails to make definite arrangements, and/or fails to clearly explain to a patient why he/she should go there.
Failure to refer to a hospital
If a GP does not arrange for a patient with red flag symptoms to attend hospital, there may be a breach of duty. This would entitle the patient to pursue a claim for medical negligence.
For more information, please contact our cauda equina lawyers today.