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Clear Policies And Processes Vital To Support Medical Centres Operating A Team Approach To Patient Care

The importance of clear communication between health providers in instances where patients are seen by multiple clinicians, was highlighted in a decision published by Deputy Health and Disability Commissioner, Deborah James.

In her decision, Ms James noted the need for providers to use critical thinking to reassess possible diagnoses when patients repeatedly present with persistent and significant symptoms that fail to respond to treatment as expected.

This case concerns care provided to a woman primarily by two general practitioners at a medical centre between 2017 and 2018, and specifically the management of her iron deficiency (anaemia), and whether there was a delayed diagnosis of colorectal cancer. The woman had been seen by several GPs at the medical centre, and by several doctors at Accident and Emergency (A&E) between 2016 and 2018, with symptoms including persistent anaemia, abdominal and pelvic pain, and diarrhoea. While overseas in 2018, the woman was diagnosed with stage four terminal cancer, and, sadly, she passed away a few weeks later.

Following a review of the woman’s treatment, Ms James found one GP in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for not providing services with reasonable care and skill. She was critical the GP did not investigate the cause of the woman’s persistent and unexplained iron deficiency anaemia more thoroughly, and considered that opportunities to diagnose and respond to her cancer several months earlier had been missed.

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She was critical that another GP at the same medical centre did not bring the results of a blood test in 2018 to the attention of the first GP. However, the majority of the care provided by the second GP was appropriate and Ms James did not find the second GP in breach of the Code.

Ms James acknowledged, "the complexity and chronicity of the woman’s medical conditions was a difficult background upon which to provide care and diagnosis".

"While several factors contributed to the delay in diagnosing the woman’s cancer, I am critical of the first GP’s inadequate investigation into the cause of her anaemia in 2017 and 2018.

"Failures by this GP meant that opportunities were missed to potentially diagnose and respond to the woman’s cancer several months earlier than occurred," says Ms James.

As a healthcare provider, the medical centre is responsible for providing services in accordance with the Code. Ms James considered the medical centre test policy to be appropriate and consistent with accepted practice so did not find it in breach of the Code.

"I consider the deficiencies in the first doctor’s care were individual failures, and I am also critical of the lack of clarity as to which GP had the primary responsibility for the woman’s care.

"This case highlights the importance of the medical centre having in place clear policies and processes to support the team based approach to managing patients, and of ensuring that clinical responsibilities are understood clearly by all care providers," says Ms James.

Following the events of this case, the GP found in breach of the Code made a number of changes to her practice around treatment of iron deficiency anaemia. The other GP has taken remedial measures including undertaking further education on management of iron deficiency anaemia and ensuring improved lines of communication between providers when there is a shared care situation.

Taking into account the actions taken, and changes made by both GPs, Ms James recommended that both GPs review the Health Pathways guidance on iron deficiency anaemia and undertake an audit of patients given oral or parenteral iron therapy in the last 12 months. Ms James also recommended that both GPs provide written apologies to the woman’s whānau.

Ms James further recommended that the medical centre consider whether any improvements can be made to its policies and processes to ensure clarity as to which GP has the primary responsibility for an individual patient’s care, and to better support its team based approach through the timely and effective facilitation of communication and cooperation between each doctor.

Editors notes

The full report of this case will be available on HDC’s website. Names have been removed from the report to protect privacy of the individuals involved in this case.

The Commissioner will usually name providers and public hospitals found in breach of the Code, unless it would not be in the public interest, or would unfairly compromise the privacy interests of an individual provider or a consumer. The medical centre has not been named in this decision as they were not found to be in breach of the Code.

More information for the media and HDC’s naming policy can be found on our website here.

HDC promotes and protects the rights of people using health and disability services as set out in the Code of Health and Disability Services Consumers' Rights (the Code).

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