The importance of clear communication between health
providers in instances where patients are seen by multiple
clinicians, was highlighted in a decision published by
Deputy Health and Disability Commissioner, Deborah
James.
In her decision, Ms James noted the need for
providers to use critical thinking to reassess possible
diagnoses when patients repeatedly present with persistent
and significant symptoms that fail to respond to treatment
as expected.
This case concerns care provided to a
woman primarily by two general practitioners at a medical
centre between 2017 and 2018, and specifically the
management of her iron deficiency (anaemia), and whether
there was a delayed diagnosis of colorectal cancer. The
woman had been seen by several GPs at the medical centre,
and by several doctors at Accident and Emergency (A&E)
between 2016 and 2018, with symptoms including persistent
anaemia, abdominal and pelvic pain, and diarrhoea. While
overseas in 2018, the woman was diagnosed with stage four
terminal cancer, and, sadly, she passed away a few weeks
later.
Following a review of the woman’s treatment,
Ms James found one GP in breach of the Code of Health and
Disability Services Consumers’ Rights (the Code) for not
providing services with reasonable care and skill. She was
critical the GP did not investigate the cause of the
woman’s persistent and unexplained iron deficiency anaemia
more thoroughly, and considered that opportunities to
diagnose and respond to her cancer several months earlier
had been missed.
She was critical that another GP at
the same medical centre did not bring the results of a blood
test in 2018 to the attention of the first GP. However, the
majority of the care provided by the second GP was
appropriate and Ms James did not find the second GP in
breach of the Code.
Ms James acknowledged, “the
complexity and chronicity of the woman’s medical
conditions was a difficult background upon which to provide
care and diagnosis”.
“While several factors
contributed to the delay in diagnosing the woman’s cancer,
I am critical of the first GP’s inadequate investigation
into the cause of her anaemia in 2017 and
2018.
“Failures by this GP meant that opportunities
were missed to potentially diagnose and respond to the
woman’s cancer several months earlier than occurred,” says
Ms James.
As a healthcare provider, the medical centre
is responsible for providing services in accordance with the
Code. Ms James considered the medical centre test policy to
be appropriate and consistent with accepted practice so did
not find it in breach of the Code.
“I consider the
deficiencies in the first doctor’s care were individual
failures, and I am also critical of the lack of clarity as
to which GP had the primary responsibility for the woman’s
care.
“This case highlights the importance of the
medical centre having in place clear policies and processes
to support the team based approach to managing patients, and
of ensuring that clinical responsibilities are understood
clearly by all care providers,” says Ms
James.
Following the events of this case, the GP found
in breach of the Code made a number of changes to her
practice around treatment of iron deficiency anaemia. The
other GP has taken remedial measures including undertaking
further education on management of iron deficiency anaemia
and ensuring improved lines of communication between
providers when there is a shared care
situation.
Taking into account the actions taken, and
changes made by both GPs, Ms James recommended that both GPs
review the Health Pathways guidance on iron deficiency
anaemia and undertake an audit of patients given oral or
parenteral iron therapy in the last 12 months. Ms James also
recommended that both GPs provide written apologies to the
woman’s whānau.
Ms James further recommended that
the medical centre consider whether any improvements can be
made to its policies and processes to ensure clarity as to
which GP has the primary responsibility for an individual
patient’s care, and to better support its team based
approach through the timely and effective facilitation of
communication and cooperation between each
doctor.
Editors notes
The full
report of this case will be available on HDC’s website.
Names have been removed from the report to protect privacy
of the individuals involved in this case.
The
Commissioner will usually name providers and public
hospitals found in breach of the Code, unless it would not
be in the public interest, or would unfairly compromise the
privacy interests of an individual provider or a consumer.
The medical centre has not been named in this decision as
they were not found to be in breach of the Code.
More
information for the media and HDC’s naming policy can be
found on our website here.
HDC
promotes and protects the rights of people using health and
disability services as set out in the Code
of Health and Disability Services Consumers’ Rights (the
Code).
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