Page Section: Centre Content Column
Failure to order investigations into abdominal pain (15HDC00207)
Download Failure to order investigations into abdominal pain (15HDC00207) (PDF 71Kb)
(15HDC00207, 26 May
General practitioner ~ Medical centre ~ Investigations ~
Tests ~ Cancer ~ Record keeping ~ Communication ~ Rights 4(1), 4(2)
A 74-year-old woman presented to her general practitioner (GP)
with abdominal pain. The GP examined her and commented that her
pain might be caused by bowel cancer. He told her that a
colonoscopy would help to confirm his clinical suspicion but, given
the lack of other contributing symptoms, she would not meet the
criteria for a public referral. The GP suggested a private referral
for a colonoscopy, which the woman declined. The GP did not conduct
any laboratory investigations regarding the cause of the woman's
pain, and instead prescribed a laxative in case her symptoms
were caused by constipation.
Four weeks later, the woman presented to the GP again with
abdominal pain, and asked whether he would refer her to a
specialist. The GP stated that given her presentation, the symptoms
would not meet the guidelines for a public referral. The GP did not
conduct any laboratory investigations at this consultation, and
continued with his plan to trial constipation medication. The GP
also asked the woman to report any rectal bleeding.
The following month, the woman presented to a different GP with
acute abdominal pain. The second GP examined the woman and
conducted laboratory investigations including blood tests. Upon
receiving the results of the blood tests, the GP immediately
referred the woman to a public hospital, where she underwent
surgery for suspected appendicitis. During surgery, a tumour was
found and a hemicolectomy was performed. The tumour was confirmed
as grade 1 colon carcinoma. Sadly, despite treatment, the cancer
progressed and the woman died.
By failing to order appropriate laboratory investigations
following the first two consultations, the first GP did not provide
services with reasonable care and skill and so breached Right 4(1).
The GP's clinical note-taking did not comply with relevant
professional standards, breaching Right 4(2).
Adverse comment was made about the GP's communication with the
woman when informing her of his clinical suspicion of bowel cancer.
The medical centre was found not to be in breach of the Code.
The Commissioner recommended that the GP audit his patients'
clinical records to ensure that patients with undiagnosed abdominal
pain have been identified, and, if necessary, have received the
appropriate testing. The Commissioner also recommended that the GP
provide a written apology to the woman's family for his breach of