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Missed diagnosis in patient presenting with sudden onset of headache (07HDC16428)

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(07HDC16428, 18 June 2008)

Medical officer in general practice ~ Accident and medical clinic ~ Headache ~ Stroke ~ History-taking ~ Diagnosis ~ Respect ~ Rights 1(1), 4(1)

The family of a previously fit and well 79-year-old woman complained about the care provided by a doctor working within a general scope of practice at an accident and medical clinic. The woman experienced a sudden onset headache. She was taken to the clinic and assessed by a medical officer (MO).

During the consultation the woman showed her current medications to the MO in order to ask more questions, but he threw the medications on the floor, telling her to forget about them as they were not the issue. Following the assessment the MO diagnosed frontal sinusitis and prescribed antibiotics. The patient experienced a severe cerebral haemorrhage later that evening and died a few weeks later.

It was held that the doctor did not take reasonable care in his history-taking and diagnosis, breaching Right 4(1), and did not treat the patient with respect, breaching Right 1(1). Although it was a borderline case, a referral of the MO to the Director of Proceedings was not warranted.

The clinic was not liable for the MO's breaches as it had appropriate policies in place to manage presentation of sudden onset headache, and a back-up doctor had appropriately been called when the clinic became busy. The MO's failings were his own and could not be attributed to the system in which he was working.