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Heart disease incorrectly diagnosed as viral infection (05HDC03782)

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(05HDC03782, 4 April 2006)

General practitioner ~ Medical centre ~ Chest pain ~ Patient history ~ Atypical presentation ~ Investigation ~ Triage ~ Standard of care ~ Professional standards ~ Right 4(1)

A 31-year-old man complained that a GP did not conduct a thorough and adequate examination during a consultation. The man consulted the GP at a medical centre, suffering from chest pain and feeling unwell. There was no identified history of cardiac problems or of heart disease within his immediate family, and he was a non-smoker. The GP completed a physical examination and found no indication of cardiac disease. He diagnosed a viral infection exacerbated by recent alcohol consumption.

Two days later, the man consulted a doctor at another medical centre with crushing chest pain. The doctor performed blood tests and an ECG and, according to those results, referred the man to a public hospital for further evaluation. The final assessment concluded that the man had suffered from multiple myocardial infarctions over the course of a few days. This resulted in permanent damage to his heart and significant residual impairment of left ventricular function with cardiac enlargement.

It was held that the first GP conducted a thorough and appropriate examination and did not breach Right 4(1). His diagnosis of a viral illness with alcohol effects was a reasonable diagnosis based on the information obtained by examination.

The first medical centre was not required to have a formal triage process in place, and thus did not breach the Code. However, a medical centre does have a responsibility to ensure that patients are seen in a timely manner.