GASTROENTEROLOGY

Analysis[1] of 85 consecutive requests for medicolegal analysis concluded that there was serious fault in half the cases.

Nearly half the cases arose out of endoscopic procedures and a large majority of these involved significant fault. Unsupervised aftercare by inexperienced support staff was a recurring theme.

PRACTICE POINT

Common features of endoscopic claims:
1.    doubtful indications
2.    inadequate disclosure
3.    substandard postoperative care

Of the 48 cases arising from clinical practice, few therapy-based claims were considered viable. Two-thirds however involved diagnostic error and 12 were judged indefensible.

PRACTICE POINT

Diagnostic errors are more often indefensible than claims related to management or treatment

Fully a third arose out of incomplete history-taking, and a quarter reflected inadequate physician awareness of diseases of the small bowel. In more than half the cases a key investigation was omitted.

Irritable Bowel Syndrome (Medical Litigation News Volume 2, Issue 5) is a common misdiagnosis).

PRACTICE POINT

Common diagnostic errors:
1.    incomplete history
2.    inadequate investigation
3.    intermittent severe pain
4.    secondopinion discouraged
5.    "Irritable Bowel Syndrome"