When Red Flags Are Missed: A Medicolegal Reflection on errors in Back Pain and Clinical Communication

Primary care risk management:

In urgent and out-of-hours care, clinicians often operate under pressure, relying on rapid assessments and interprofessional communication. But when a patient presents with symptoms that could indicate a serious neurological condition, the margin for error narrows. This anonymised case explores how a general practitioner responded to a consultation request from an allied health professional regarding a patient with escalating back pain and neurological symptoms—and what lessons can be drawn when red flags are potentially overlooked.

---

Medicolegal case study:

A man in his mid-40s presented to an urgent care setting with worsening lower back pain, radiating leg symptoms, and difficulty walking. He had a history of spinal issues and was awaiting diagnostic imaging. An allied health professional consulted a GP for advice on pain management. The GP, not acting in a supervisory role, did not examine the patient directly but offered advice based on the colleague’s assessment. The patient later required urgent spinal intervention.

---

Key Clinical Questions regarding missed red flags in urgent care and clinical errors:

1. Can a GP rely on another clinician’s assessment in urgent care?Yes—within reason. In many urgent care environments, allied health professionals such as paramedics, physician associates, or advanced clinical practitioners work autonomously. A GP may reasonably rely on their clinical judgement, especially if the colleague is an independent prescriber. However, the GP should still ensure that key safety questions—such as the presence of red flag symptoms—have been addressed.

2. What if the patient described “sitting on bubble wrap”?This unusual sensory description may indicate altered perineal sensation—a potential red flag for a serious spinal condition. If such a symptom had been communicated to the GP, it would have warranted further assessment or urgent referral. However, the records did not clearly confirm that this symptom was passed on.

3. Should the GP have spoken directly to the patient?Not necessarily. The GP was consulted specifically for medication advice and was not in a supervisory role. It was within the range of accepted practice to rely on the allied health professional’s assurance that no red flags were present. That said, if contradictory information had emerged, a more direct assessment would have been warranted.

---

Medicolegal Insights:

This case highlights the importance of:

• Clear, structured communication between clinicians, especially when symptoms could indicate a progressive neurological disorder.

• Documenting red flag screening explicitly, including what was asked and what was observed.

• Recognising unusual symptom descriptions (like “sitting on bubble wrap”) as potential indicators of serious pathology.

  

  Back Pain and Red Flags: A Medicolegal Urgent Care Review