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Failure to diagnose or a delay in diagnosis of medical
conditions is one of the most common complaints we have from
clients when it comes to medical services. Delay in treating a
medical condition can be devastating for a patient.
In this article we will look at health providers'
obligations, the importance of diagnosis and diagnosis when it
comes to more serious conditions such as cancer. We also outline a
case study where a doctor's report was found to be negligent
and ultimately the cause of a delay in diagnosis of bowel
cancer.
What are the health provider's obligations?
Health providers have a duty to exercise reasonable care and
skill when providing advice and treatment. This duty extends to the
examination, diagnosis and treatment of the patient and the
provision of information.
Patients have various rights and should be given appropriate
information about the potential risks of a procedure or treatment
to allow them to make an informed decision about whether to go
ahead with the recommended procedure or treatment.
How does diagnosis fit into the picture?
Accurate and timely diagnosis of a medical condition is needed
to determine what procedure or treatment is required to rectify or
ease the medical complaint.
Health providers have available to them a multitude of
investigations to assist in diagnosing medical conditions.
Complaints made by a patient, as well as signs and symptoms, should
allow health providers to determine what investigations are
required to assist with diagnosis.
Investigations are undertaken not only to assist with making a
diagnosis but also to eliminate medical conditions.
Although it would seem reasonable to assume that a bone fracture
is a straightforward condition to diagnose, we have seen matters
where there has been a delay in diagnosing and treating a fracture
due to a failure to refer the patient for a scan, which has
ultimately compromised the patient's recovery.
What about more sinister medical conditions such as
cancer?
Colon cancer is one of the most common cancers suffered by
adults in Australia and because of this, there is a national
screening service in Australia. Studies indicate that early
detection, such as by faecal occult blood screening, can lead to a
reduction in mortality. Screening has the potential for diagnosis
even at a pre-malignant stage. Polyps in the bowel can become
cancerous and if the polyps are identified at an early stage they
can sometimes be removed via colonoscopy before they turn
malignant.
Early detection of such conditions is ideal. For example, if
colon cancer is detected at an early stage before penetrating the
muscle of the bowel, then prognosis for the patient is considered
more favourable. Further, early detection may avoid the need for
more invasive treatments such as chemotherapy.
Case study
In the recent decision of Mazza v Webb [2011] QSC 163,
the Supreme Court of Queensland was critical of medical services
provided by a specialist doctor (the defendant). The patient (the
plaintiff) had symptoms of vomiting, abdominal pain, diarrhoea and
weight loss and was referred to the defendant for investigation. In
February 2004 the plaintiff underwent an endoscopy conducted by the
defendant.
Following the procedure, the defendant provided a report to the
plaintiff's GP indicating that the endoscopy was normal,
although it had revealed villous atrophy, consistent with
continuing coeliac disease.
Ongoing symptoms resulted in the plaintiff undergoing a further
endoscopy in May 2005 revealing a small bowel carcinoma, which was
removed. The plaintiff required chemotherapy.
The Court was not satisfied that the defendant had breached his
duty to conduct a more extensive endoscopy in February 2004,
however, considered that reasonable care required that the
defendant inform the GP, and the plaintiff, that his investigation
had been limited and that it had not provided a satisfactory
explanation for the plaintiff's symptoms.
The Court concluded that the defendant's report was
negligent and that his negligence, by reporting as he did, was
causative of the plaintiff's damage. The delay in diagnosis had
extended the plaintiff's recovery. The plaintiff was awarded
damages.
Advances in medical science and the increased ability for
patients to access a wealth of information via the internet will
hopefully lead to a reduction in complaints involving a failure to,
or delay in, diagnosis.
Importantly, as a patient you have the right to ask questions
about your medical condition or symptoms, and have the right to
seek a second opinion, particularly if you are not satisfied with
the medical services provided by a health provider.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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