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Diagnosis of a subarachnoid haemorrhage (12HDC00281)

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(12HDC00281, 12 December 2013)

General practitioner ~ Accident and medical clinic ~ Sudden onset headache ~ Subarachnoid haemorrhage ~ Right 4(1)

A 48-year-old woman suffered a sudden onset headache while at home. She was taken to an accident and medical clinic where she was triaged, and a short time later she was assessed by a doctor. The doctor did not obtain the woman's full history, including smoking history and did not refer her to, or have a discussion with, the on-call medical registrar, contrary to the clinic's policy on sudden onset headache. The doctor diagnosed the woman with migraine brought on by alcohol. The doctor prescribed the woman with anti-nausea and anti-inflammatory drugs to be given intramuscularly.

The doctor then handed the woman's care over to another doctor for monitoring because her shift finished. The second doctor reviewed the woman twice. Following the second review he noted that the woman's pain had improved from 10/10 to 7/10 on a scale of one to ten with 10 being the worst pain and zero being no pain. The second doctor then discharged the woman.

The following morning the woman was found collapsed at home. She was transferred to hospital where she was diagnosed with a subarachnoid haemorrhage (large bleed in the brain). She died later that morning.

It was found that the first doctor breached Right 4(1) for failing to obtain a full history and fully investigate the possible diagnosis of subarachnoid haemorrhage. The doctor was criticised for retrospectively adding to her records but not annotating the addition as such.

The second doctor was not found in breach of the Code. However, it was found that he demonstrated a lack of critical thinking and records of his consultations with the woman were suboptimal.

The accident and medical clinic was found to have adequate policies in place in relation to management of patients presenting with sudden onset headache. Although not the subject of this complaint, the adequacy of the accident and medical clinic's complaints management in this case was criticised, as were the actions of the nurses involved in the woman's care.

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