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Assessment Of A Girl Seen By Multiple General Practitioners

Health and Disability Commissioner Anthony Hill today released a report finding the Palms Medical Centre (The Palms) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for its failures in relation to its care of a young girl.

Over the course of just under a month, the girl saw a doctor four times. Of the four times, three were at The Palms and one was at another medical centre. Her symptoms included intermittent fevers, multiple sore joints with no confirmed history of injury, and weight loss.

At her appointments, the girl was treated episodically, and when X-rays showed no musculoskeletal cause for her symptoms, the doctors sought no further investigations to explore the cause. After an appointment with her usual general practitioner on 18 January 2019, she was taken to hospital. One week later she was diagnosed with acute rheumatic fever (ARF). She was kept in hospital on strict bed rest for several months.

Mr Hill acknowledged the difficulty in making the girl’s diagnosis, as her presentation was unusual for ARF. He considered that the issue was not the failure to make the correct diagnosis earlier, but the failure to investigate the child’s multiple deteriorating presentations which meant that she was denied the opportunity for earlier diagnosis and treatment. Accordingly, the Palms was found to be in breach of the Code.

Mr Hill said "This case highlights the shortcomings of treating patients episodically, and the importance of critical thinking when a patient presents multiple times in a short timeframe, particularly when multiple providers are involved. Critical thinking and good inter-provider communication are essential."

Mr Hill recommended that The Palms apologise to the girl’s family, which it has done. He also recommended that the Palms prepare an anonymised case study on the girl’s care for training all clinical staff and consider facilitating a regular clinical meeting for review of patients who have seen multiple providers for the same or similar complaints over a short period, or in whom a diagnosis is proving elusive

This report can be read in full on our website

https://www.hdc.org.nz/decisions/search-decisions/2020/19hdc00695/

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