Cases of medical negligence involving general practitioners in Ireland have been steadily increasing over the years. Based on the findings of a systematic review of international malpractice claims in primary care carried out at the Royal College of Surgeons in Ireland in 2013, missed diagnosis was found to be the most common source of malpractice claims.
Among adults, cancer and heart attacks were the most commonly missed diagnoses, whereas meningitis and cancer were the conditions which most regularly received improper treatment in children. The second most common reason for claims came from errors in prescribing medication.
Life-changing consequences can flow from the most basic of clinical or administrative errors. Unfortunately, these mistakes can and do occur all too readily in an over busy GP’s practice where adequate time is not afforded to patients or paperwork is not properly filed or followed up.
Examples of typical failings which have resulted in claims of malpractice include:
• misdiagnosis of breast and colon cancer and cancers of the skin, female genital tract and lungs;
• misdiagnosis of myocardial infarction and other heart problems in adults, with these commonly being mistaken for gastric complaints;
• misdiagnosis of appendicitis and meningitis in children;
• failing to act upon malignant biopsy findings resulting in cancer going untreated for months or even years;
• prescribing anti-sickness medication in cases of acute diabetes;
• delays in identifying cases of breast cancer, due a misdiagnosis of mastitis or other less serious illness;
• failure to promptly treat diabetic ulceration, resulting in avoidable amputation;
• prescribing potentially fatal amounts and combinations of medication, especially among elderly patients.
Over half of all cases involve misdiagnosis by the GP, with the next most common complaint being a doctor’s failure to refer the patient for tests or to see a specialist, followed by injuries sustained due to mistakes involving the patient’s medication.
The most common conditions GPs miss or take too long to identify are cancers, infections, fractures, heart attacks, meningitis, ectopic pregnancy, and blood clots.
Sometimes the failure to diagnose the true nature of the illness may be down to the initial symptoms proving inclusive, in which case a GP will not have any exposure. However, there are worryingly common instances of malpractice resulting in a failure to diagnose, including:
• not taking a full history or examining the patient;
• not arranging an urgent referral or investigation;
• failing to keep proper records of phone calls and home visits; and
• not arranging follow-up appointments with patients whose symptoms might be suggestive of cancer or other serious illness.
Unfortunately, one of the negative consequences of this increase in medical negligence claims against GPs is that family doctors are now reported to be practising in a more defensive manner, which has led to more patients being unnecessarily referred to consultants, when the real solution is to ensure that effective systems are in place in the practice and that each patient is afforded enough time and attention to ensure that proper diagnosis and treatment are achieved.