Abstract
Mr B, a 42-year-old salesman attended his GP surgery in early May 2005 with feelings of fatigue and malaise. Clinical examination was unremarkable and a variety of blood tests were ordered including full blood count, urea and electrolytes and liver function tests (LFTs). The samples were taken the following day by the practice phlebotomist. The ‘clinical information’ box on the request form was left blank.
Four days later, when the requesting GP was on holiday, the results of all tests returned to the practice. They were reviewed by one of the partners who did not know Mr B and was later unable to recall if he accessed the clinical records. However, the note of the consultation only read ‘tired all the time’. Most of the results were unremarkable but there was a slight disturbance of the LFTs. The biochemist had commented ‘?alcohol’. The GP was not unduly concerned and ticked the ‘file’ box, believing his partner would discuss the patient's drinking habits when he was next seen.
Mr B phoned the practice the following day to ask about his results and was told by a receptionist that his results were ‘normal’. Mr B did not return to the practice but was admitted to hospital 2 years later and found to have significant liver damage as the result of undiagnosed haemochromatosis.
After reviewing their client's GP records, Mr B's solicitors intimated a negligence claim against the practice for not acting on the ‘obvious abnormality detected which would have avoided their client suffering harm.’
This case highlights some of the risk management issues practices need to address in relation to results handling including:
Ensuring the correct test is done. Who completes the request form? Are there adequate details for the correct test or follow-up tests to be done? How often do you consult the lab when deciding which investigations are appropriate or what results signify? Ensuring results are seen by someone in a position to interpret them. Many subtle abnormalities can be difficult to interpret unless the clinician reviewing the results has adequate information to make a judgement. A clear record of the person making decisions on the results should be made. Ensuring abnormal results are acted on. When it is decided to ask the patient to ‘see the doctor’, is there a system to spot patients who default on their appointments?