Missed or delayed diagnosis

You have been treating a 35 year old woman for four years. the patient present; do not just give the patient a referral During that time she has had classical migraine symptoms which usually respond to ergotamine and analgesics. In the last year 4. Maintaining contact with the patient and enquiring
they have been more frequent and prophylaxis with Deseril has periodically about their progress may help the patient cope with the feelings of concern over the diagnosis or any She again presents with the usual symptoms but has noticed possible delays. Expressions of personal concern and interest some face numbness and a more frequent pattern of occurrence. in what has occurred (i.e. an admission to hospital or other A CT scan report shows a 4 cm meningioma in the right temporal treatments) is part of good ongoing care and will assist in the area which clearly has been there for a long time.
ongoing doctor-patient relationship.
5. Offer ongoing care when the crisis period has past. If you
How to handle the situation?
have had a good relationship previously it is likely the patient At some time all of us will face such diagnostic challenges. They will wish to continue under your care. If the patient requests may be less dramatic or more serious. ‘Could/should this have referral to a new doctor, facilitate the transfer and offer to been picked up earlier?’ is an obvious question the patient will put provide the new doctor with all the details or copies of the to you – and one which requires an answer. Your response will set Investigate the cause of the delayed diagnosis.
reaction after such an experience would be to over-investigate every patient presenting with a headache. It is more sensible to consider your thoughts and decisions in relation to the management of the patient and develop objective criteria for the management of common clinical problems.
If the delay was caused or contributed to by a systems error such as follow-up failure or misfi ling of pathology or x-ray reports, tighten up your systems to prevent a recurrence. Avant can advise you about current practice standards for investigation tracking and follow-up systems. 7. Change and inform. Importantly, while we would
recommend you seek advice from Avant before taking this step to avoid making any admissions of liability, it is noted that telling the patient about the steps you have taken to minimise the risk of a repeat of this situation can reassure the Suggested next steps?
patient that some learning has come from what happened to them.
1. Arrange urgent review. Depending on the urgency of the
8. Notify Avant about the incident. Notify Avant as soon as
diagnosis, arrange to contact the patient for review so that possible after you become aware of the incident. If you receive you can inform them of the unexpected fi nding and its a letter of complaint from the patient or their representative, implications. A personal telephone call and then a face to do not answer them without fi rst obtaining advice from Avant.
face conversation is the most appropriate course,rather than delegation to another member of the practice.
9. Consider cancellation of fee. Avoid sending accounts and
reminders where these will infl ame the situation. It is better 2. Explain the situation and the new fi ndings in a face to face
to forego a fee than risk offending the patient. Patients will discussion. Say how sorry you are about the unexpected news. often forgive human error but they never forgive error plus Explain what treatment may be necessary and what it would perceived greed or arrogance. Not sending a bill is not an 3. Arrange for immediate treatment of the diagnosis.
This may require referral for additional tests and specialist treatment. Preferably arrange these through a phone call with Avant Mutual Group Limited0746–0610 What if another doctor is responsible for the
Things to remember!
misdiagnosis and you have made the correct
diagnosis?
• Take immediate action to treat and correct errors 1. The steps 1, 2, and 3 above apply.
• Refer immediately for urgent treatment 2. When discussing the diagnosis and its implications, stick • Maintain interest in the patient’s progress to the facts. You have one side of the history and as such • Avoid sending accounts for incorrect treatment it is better to avoid any implied or stated criticism about the person or persons who may have been responsible for • Avoid unnecessary or derogatory comments about your the previous treatment. It is not uncommon for legal claim or complaint to be pursued by a patient after throw away • Notify Avant about adverse incidents and complaints – comments by the receiving doctor, some of which were not if in doubt about whether to notify, contact us anyway.
intended to be a criticism. Remain professional and objective Reference
1 Terry L Wahls and Peter M Cram (Iowa). The frequency of missed test results 3. If at a later date the patient’s solicitor seeks a report in and associated treatment delays in a highly computerized health system. BMC the investigation of a compensation claim, keep the report objective and avoid criticism unless you are asked to provide an opinion as an expert witness. Contact Avant if you are unsure what is required.
4. As a guide: do what you would have the other doctor do if the roles were reversed. This might include informing the other doctor of the correct diagnosis and, if the patient agrees, offering to send the patient back to that practitioner so that they have an opportunity to explain. All too often the fi rst inkling of an error or patient dissatisfaction is when a doctor receives a writ or a solicitor’s ‘letter before action’ which proposes negligence proceedings.
Genuine care and concern is called for when a patient suffers
an adverse outcome of treatment or diagnostic error.
Disclaimer
This information is general information relating to legal and/or clinical issues within Australia. It is not intended to be legal advice, nor and should not be considered as a substitute for obtaining personal and specifi c legal and/or other professional advice. Avant Mutual Group Limited and its subsidiaries will not be liable for any loss or damage, however caused (including through negligence), that may be directly or indirectly suffered by you or anyone else in connection with the use of information provided in this forum. Avant Mutual Group Limited0746–0610

Source: http://www.avant.org.au/uploadedFiles/Content/Resources/Member/Risk-201007-Missed-Or-Delayed-Diagnosis.pdf