By the time of the patient’s death the risks associated with diclofenac were well known, the coroner’s report says. It points out published guidelines and bulletins recommend gastro-protective medicines for patients on long-term, high-dose non-steroidal anti-inflmmatory drugs (NSAIDs), particularly for those in the older age group.
Expert witness, clinical pharmacologist and endocrinologist Matt Doogue told the coroner such medication substantially reduced the risk of an ulcer and Mrs Maindonald probably should have been prescribed a medicine such as omeprazole.
Mrs Maindonald’s care was taken over by another GP in 2011 who also did not prescribe a drug to protect her stomach.
Through a lawyer, the GP told the coroner the first time he saw Mrs Maindonald he had a short discussion about the need for her to take medication such as omeprazole but she made it clear she was not interested.
He raised the issue on subsequent occasions but the patient’s attitude was that she had been on diclofenac for many years and had experienced no problems with it. She was not interested in taking other medication. He regularly asked her about side effects from the diclofenac.
The GP said patients had the right to make their own choice but, in hindsight, he could have been more assertive in encouraging her to take protective medication.