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Failure to follow-up on recommendation to investigate rectal bleeding (15HDC00660)
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(15HDC00660, 22 June
General practitioner ~ Medical centre ~ Rectal bleeding ~
Recommendation follow-up ~ Right 4(1)
A woman consulted her general practitioner (GP) due to
tiredness. A blood test was arranged, which revealed borderline
iron deficiency (low ferritin). The results were discussed with the
woman at a later appointment. The GP considered that the woman's
low ferritin was secondary to her menstruating and physical
exercise. Iron supplements were prescribed, which addressed the
Approximately a year later, the woman self-referred to a sports
physician with regard to her tiredness and inability to gain
weight. The physician noted that the woman was experiencing rectal
bleeding and blood in her bowel motions weekly. He wrote a
reporting letter to the GP making recommendations for the woman's
ongoing care. The physician's suggestions for management included
investigation of the source of the woman's lower gastrointestinal
bleeding. He also arranged blood tests and asked the GP to follow
up the results.
The following week, the woman consulted the GP again. She took a
copy of the sports physician's letter to the consultation, and told
HDC that the GP referred to the letter during the consultation. The
GP dealt with a number of the recommendations made in the
physician's letter regarding the woman's management. However, there
is no record in the clinical notes of any attempt to clarify the
rectal bleeding reported in the letter, or to take any action in
relation to it.
The GP reviewed the woman approximately twice a month during the
following months in relation to other health matters. Further blood
tests were performed throughout that year and the next year, which
returned normal results. There is no reference to rectal bleeding
in the clinical notes for any of the consultations in those years.
The woman does not recall whether she raised the issue of rectal
bleeding at subsequent consultations.
Approximately two years later, the woman suffered a bout of
diarrhoea and experienced some rectal bleeding. She consulted
another GP at the same medical centre, who performed a rectal
examination and recommended a colonoscopy. The woman was referred
to a gastroenterologist and underwent a colonoscopy, which revealed
a tumour. Subsequently she was diagnosed with colorectal
It was held that by failing to follow up on the recommendation
made in the physician's letter regarding the woman's rectal
bleeding, the GP failed to provide services to the woman with
reasonable care and skill, and breached Right 4(1).
The medical centre was found not to have breached the Code.
It was recommended that the GP apologise to the woman and,
should the GP return to practice in New Zealand, that he undertake
further education and training regarding managing correspondence
and the diagnosis and treatment of colorectal cancer at an agreed
workshop with the Royal New Zealand College of General
Practitioners, and provide evidence to HDC of having completed this
It was also recommended that the medical centre review its
system for managing incoming correspondence and test results, and
report the outcome of the review to HDC.