Consideration Of Alternative Diagnoses For Coccyx Pain

Health and Disability Commissioner Anthony Hill today released a report finding a General Practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failing to adequately assess and consider alternative diagnosis for a man presenting with pain in his tailbone area.

The man consulted the GP following a fall. A month later, he saw the GP again twice about pain in his general tailbone area, and a change of bowel habit. The GP considered the man had a sore coccyx from the fall. Over the next two months, the man attended the practice multiple times, seeing other GPs, with persisting pain in that area but his rectal area was not examined. At the end of the two month period, the first GP referred the man for a colonoscopy. The man then transferred to another GP clinic and was diagnosed with rectal cancer.

Anthony Hill considered that the first GP failed to assess the exact location of the man’s pain. Given the man’s change in bowel habit, the GP should have considered alternative diagnoses. Mr Hill was also critical that the first GP failed to perform a rectal examination and that the referral for a colonoscopy contained insufficient information.

"This report highlights the importance of considering differential diagnoses for a patient’s symptoms, and of conducting appropriate tests," Mr Hill said. "In my opinion, a lack of critical thinking by [the GP] precluded consideration of an alternative diagnosis for [the man’s] symptoms."

Mr Hill also criticised two other GPs at the practice who saw the man and failed to take all the necessary steps to investigate his symptoms. He recommended that the three GPs apologise to the man’s wife and undertake further training on colorectal cancers, and that the medical centre report back to HDC regarding the review of its processes as a result of this investigation.

The full report for case 18HDC02354 is available on the HDC website.

https://www.hdc.org.nz/decisions/search-decisions/2020/18hdc02354/

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