GP Failed To Properly Assess A Man Who Was Days Away From A Heart Attack
Deputy Health and Disability Commissioner Kevin Allan today released a report finding a locum GP in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for undertaking an inadequate assessment of a man in her care.
The man, in his sixties, had a history of diabetes, hypertension, and heart disease. He saw a locum GP because he’d been having indigestion and a lack of appetite for several months, had a fever and was exhausted.
The locum GP discussed with the man his symptoms, recent medical notes and medications, and diagnosed him with gastritis. She prescribed medication and advised him to take antacids if needed. A follow up appointment was made for a month’s time.
Sadly, two days later the man collapsed at home from a heart attack and died shortly afterwards.
The Deputy Commissioner considered that the assessment undertaken by the GP was inadequate, in light of the man’s significant clinical history. The GP did not carry out appropriate questioning and investigation into his symptoms to exclude more serious cardiac conditions.
"The man presented with symptoms known to be related to atypical presentations of cardiac ischaemia," said Mr Allan.
"During the consultation, the locum GP did not ask the man questions to try to identify whether there were other possible diagnoses that might explain his symptoms or explore the cause of his exhaustion."
"She diagnosed the man with gastritis, despite being aware that this diagnosis didn’t explain his fever or headache, and that he had been taking Mylanta for several months, which hadn’t eased his symptoms," he said.
The Deputy Commissioner considered the consultation was a missed opportunity to understand whether the man required further medical treatment, and the locum GP did not provide services to the man with reasonable care and skill.
"This case highlights the importance of health providers considering other possibilities for presenting symptoms, and of considering a person’s clinical history and risk factors adequately," said Mr Allan.
Mr Allan recommended that the locum GP review the Best Practice Advocacy Centre guidance on the immediate management of acute coronary syndromes in primary care, and provide HDC with an analysis of typical and atypical presentations of angina, and what steps to take when a patient is presenting with cardiac symptoms.
He also recommended the locum GP review the Royal New Zealand College of General Practitioners standard "patient records meet requirements to describe and support the management of health care provided", and provide a written apology to the man’s family.
The full report on case 19HDC01874 is available on the HDC website.