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Care and treatment of abdominal and pelvic symptoms (05HDC00985)

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(05HDC00985, 7 June 2006)

General practitioner ~ Medical centre ~ Dysmenorrhoea ~ Menorrhagia ~ Abdominal and pelvic pain ~ IUD removal ~ Standard of care ~ Documentation ~ Vicarious liability ~ Rights 4(1), 4(2)

A woman complained about the care and treatment provided by two GPs in the same medical practice. She presented on four occasions over a period of four months complaining of dysmenorrhoea (painful periods), menorrhagia (heavy periods) and abdominal and pelvic pain. She was admitted to hospital after the fourth consultation and had urgent surgery the following day to drain approximately 1.3 litres of pus from her ruptured fallopian tubes and ovaries. 

It was held that the care provided by her own GP on her first visit was satisfactory in the circumstances. However, on a later visit his investigation of the woman's symptoms and the follow-up advice he provided were inadequate, and a breach of Right 4(1). His notes of the consultation were deficient and breached Right 4(2).

It was held that the other GP's care breached Right 4(1) as she failed to investigate acute and ongoing symptoms appropriately. Her record-keeping for both consultations amounted to a breach of Right 4(2), as she omitted documenting important clinical findings from an abdominal and pelvic examination, leaving a future doctor unclear of the follow-up required.

It was also held that the medical centre did not breach the Code as the woman was appropriately triaged. As the GPs' breaches of the Code resulted from their respective independent clinical judgement, the medical centre was held not to be vicariously liable.

This case highlights the importance of prompt investigation of acute and ongoing symptoms, and the need for timely follow-up with patients when they fail to re-present as advised. It also highlights the importance of clear and comprehensive documentation to ensure continuity of care where a patient consults two or more doctors within the same practice.