Postman, 61, died in his van after remote GP misdiagnosed symptoms over phone

A postman was found dead in his own van after a remote GP failed to spot that he had ruptured an ulcer on his foot.

James Dow, 61, who had spoken to his GP three weeks before he died, suffered severe blood loss while he was on duty in October 2021.

An inquest into his death in Winchester, Hampshire, heard from family doctor Elizabeth Anne Wilson – now retired – who said she would have seen Mr Dow had an ulcer if she had seen him in person.

Dr Wilson, who worked at the Ringwood Medical Practice, was told that Mr Dow was suffering swelling in his left foot and leg.

She said that during the remote appointment, Mr Dow had not described his symptoms properly and was told that he was probably suffering from gout – something he had previously suffered with.

Dr Wilson told the inquest that Mr Dow had failed to mention the ulcer on his foot or the brown discolouration of his skin he had spotted during the telephone consultation, that took place when GPs were told to assess patients remotely to stop the spread of COVID.

She said that if she had been told about the ulcer or discolouration, she might have requested he send a photo and book a face-to-face appointment.

Asked why she had not asked for a photograph, Dr Wilson replied: "He didn’t mention the changes to the colour of his foot – he mentioned no ulcers or discolouration. I can only act on the information I’m being given by the patient."

She added that during a follow-up phone consultation, Mr Dow told her the swelling had "settled" and made no mention of the ulcer or discolouration.

But Mr Dow’s family hit out at the lack of face-to-face appointments, saying he would still be alive if he had been able to show physical evidence of his condition.

Mr Dow's younger son Jamie, 23, told the inquest: "It was not a diagnosis – she said 'let’s go with gout'. It’s more of a guess than a diagnosis.

"The symptoms of gout were not what he described to her."

Mr Dow's eldest son Theo, 26, added: "The fact is that he wasn’t seen by a doctor and he was diagnosed on the phone.

"The outcome would have been different if he had gone into the surgery as she have been able to see it. They didn’t do their job."

England was not in lockdown at the time of Mr Dow's death but many GPs were still insisting on telephone consultations before face to face appointments were made.

Theo Down went on: "All through COVID, the fact that people were not seen – I am sure people had problems that were not diagnosed. Doctors still have a duty of care.

"In her own words, (the doctor) said the ulcer would have been visible. She would have known what it was."

Mr Dow's wife, Nina, 54, added: "People are not getting the care they need as well as the diagnoses. There's no duty of care.

"It's happening to other people – people are not getting the treatment they need."

Coroner Jason Pegg said that Mr Dow’s death was caused by the 2cm ulcer on his left foot which ruptured and caused severe blood loss.

A pathologist’s report said that the ulcer was 3mm from an artery, which may have exacerbated the blood loss when the ulcer ruptured.

At the inquest, the coroner said: "(Mr Dow) didn’t report the discolouration to the doctor. I don’t know why he chose not to tell the doctor.

"Might be, from what we heard, because he was quite a stoic individual."

Figures released in October last year found that the proportion of people seeing their GP in person was higher than at the start of the pandemic for the first time.

More than two-thirds of appointments (68.1%) with family doctors in England were carried out in person in September 2022, according to the data from NHS Digital.

This was the first time the proportion of face to face appointments was above the 66.2% recorded in March 2020, the month the country went into its first national lockdown.

However, a survey of more than 2,000 adults found that three out of four people (72%) had tried to get a face-to-face GP appointment in their local area last year, with 43% proving successful while 29% were not.