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Failure to order investigations into abdominal pain (15HDC00207)

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(15HDC00207, 26 May 2016)

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 the Code.

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