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Management of abnormal test result (10HDC01419)

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(10HDC01419, 5 April 2012)

General practitioner ~ Medical centre ~ Skin condition ~ Multiple myeloma ~ Abnormal test result ~ Misfiling of result ~ Follow-up ~ Rights 4(1), 6(1)(f)

A 69-year-old man consulted a homeopath about a skin condition, and was asked to have a blood test prior to the consultation. His GP organised the blood test and received the results. The results were normal, except for one result (a measure of proteins in the blood) which indicated that further review and surveillance were necessary. The GP discussed the results with the man and they decided to carry out follow-up tests.

The man had follow-up blood and urine tests. The results were positive on the Bence Jones Protein test, which is an indicator for multiple myeloma (a bone marrow cancer). The test results were noted by the GP as abnormal. The GP's usual practice with abnormal test results was to leave them in his "practitioners inbox" until he determined the appropriate course of action to be taken. In this case however, the GP inadvertently filed the result in the man's patient inbox. The GP did not attach a reminder to the result.

The man consulted the GP later that month, prior to an overseas trip. The GP did not look at the man's patient inbox, did not inform the man of the significant result, and did not refer him for specialist advice.

While overseas on holiday, the man suffered from severe back pain and was hospitalised. On his return to New Zealand, he was hospitalised again and diagnosed with multiple myeloma.

While the GP correctly marked the Bence Jones Protein test as abnormal, he did not advise the man of the abnormality, or refer him to a specialist. It was held that the GP's failure to inform the man of the test results, and failure to take appropriate action to ensure the man's abnormal test results were further investigated, was a breach of Rights 4(1) and 6(1)(f) of the Code.

Doctors owe patients a duty of care in handling patient test results. This case highlights the need for general practitioners to utilise the tools available to them to ensure abnormal results are acted on appropriately. These include the various reminder systems present in their practice management systems, such as patient and provider task manager, recall module and patient alerts.

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