hospital saying I should have informed them

[Mharhi]

about my previous medical history on admission to A and E? I just got back a complaint response and apparently it may have made a difference if I 'had alerted staff to my previous colonoscopy' when I came into casualty. However I was in a lot of pain, bleeding and taking tramadol, just felt at the time up to answering what they asked me. And what they asked was very specific "have you a history of inflammatory bowel disease?" then came back and said "sorry they forgot to ask had I ever had bowel cancer or family history of it?"

Now they are saying I didn't make them aware of a benign tumour which was in the colonoscopy report...argh..

Shouldn't they have a checklist or something to ask people? I already feel so bad I didn't alert them, I didn't know the report was important or was aware the lesion mentioned was a tumour...

I also would have thought the person checking me in should have checked out on the computer my past records?

In an ideal world, yes, you should have told them about the tumour. However it sounds like you didn't fully understand your own medical history or know that it was something that could cause complications. Did anyone ever talk you through the colonoscopy report or did you just get it in the post?

They wouldn't have had enough time to receive or read your notes - they do have to go on what you can tell them.

However if you work in emergency medicine I would have thought you have to be pretty careful about the way you take histories (ie start with open questions e.g.: 'Do you have any history of bowel or stomach problems?'), and know that your patients are often frightened and not likely to be thinking straight - you must know you have to work quite hard to make sure you have a decent history. After all - your DH didn't think of it and he wasn't the one who was bleeding everywhere and on Tramadol! And if they initially forgot to ask you if you had had cancer then it reinforces the impression they were not totally on the ball with taking the history.

Thanks yes it was a muddle with the history, I think they were astonished with what happened too, this is awful to say but in a panic i had cut the thing off and poor DH had brought it in wrapped in cling film! (how romantic!)

So they were em, able to see it clearly. It was about the siza of a small egg. They said they had never seen anything like it before and i think it just threw them, they were sending it off in formaldehyde to get examined then unfortunately the surgeon didn't get to see it.

So maybe that's why they just thought 'cancer' and just asked that one question and the IBD one..

honestly the colonoscopy did go through my mind and I thought but that was fine maybe things have changed since then..

I am a bit cross with the response the gave, I just looked at it again, it just repeatedly says that if I'd informed them then they would have operated sooner and not sent me home for a sigmoidoscopy the following week. However in the guidance for writing complaints for patients it says not to repeat yourself and just stick to the facts. I feel it's just trying to put the blame on to me, possibly focusing on that one thing i could have done rather than anything else.

i may well have not had that previous test, then what? So it's still ok to send someone home with a bowel obstruction? A CT scan would have picked it up straightaway and the lipoma. They haven't answered lots of things in my complaint and just focused in on this.

It must have been a horrible experience. It's good that you're OK now.

I can't say exactly what tests they should have done before discharging you, but perhaps if you go down the independent medical opinion route you will find out whether what they did was reasonable given what they knew at the time.

I still think there is some fault on both sides: you could have helped a lot by telling them about the colonoscopy. OTOH coaxing the right information out of scared and confused people in the middle of the night must be a large part of A&E staff's job, and it's not unreasonable to expect them to be skilled at it.

I think PestoPenguin's post about the importance of medical communication is spot on.

well I wouldn't know that a lesion is medical speak for tumour

It isn't.

I should explain the bathroom was covered in blood. The tumour had caused an extremely rare telescoping effect in the bowel and pushed out

So you arrived in A/E, with something very rare and gave an innacurate record of your medical history.

Your husband having IBS IS relevant, because although you don't have it you know someone who does - therefore you know the symptoms so you are more knowledgable about IBS than most people who don't have it.

You have had a hard time, I know, I have been rushed into A/E with abdo pain 4 times. It is frightening and the questions can seem irrelevant, and it can be heard to think straight.

I hope everything is well now.

I've always found (haven't had major stuff too often) that actually you get asked a whole range of questions, and get asked them by each and every person time and time again, so this surprises me.

Even questions which can seem quite irrelevant, but obviously can indicate other problems that could go missed.
so, obv. you get blood pressure/temp, heart rate etc done.

then get asked about food/diet/weight/exercise/fatigue & loads of other general stuff, then things that cover every possible symptom to do with what they suspect, and even what they've already ruled out, to make sure that they get stuff right.

PLUS - any previous symptoms/allergies/operations/meds etc etc.

I would have expected that tbh, not just a couple of questions. In fact, it's always felt like they ask a ridiculous number of questions before even coming up with any kind of suggestions/med/treatments, but then diagnosis is the key, and it the THE DOCTORS job.

I think that you'd be justified in complaining about the complaint. What if you hadn't been able to speak? Would that justify sending you home? Of course not. You are a patient in distress, needing their medical expertise. Of course previous knowledge can help, but they shouldn't be relying on it.

You handed them a bit of the lipoma. So they knew for sure there was some sort of mass in your bowel. In that case, the decision about the urgency of your treatment would not have been altered by their knowing there had been a polyp several years before. It might have made it less urgent, rather than more.

It was poor history taking not to guide you into mentioning previous bowel problems, to be honest. Drs are trained to ask open ended questions. 'have you had any stomach problems before' 'have you been in hospital for anything, or under your GP for anything?' is more likely to get the correct information than 'do you have IBS?'. Hope you're getting better.

You handed them your polyp, that you had cut off yourself at home?

If you are planning on suing the hospital you will have to get an independent report anyway, and that will guide you on where any deficits lie.

You...cut?...the...thing...off?..

Seriously, I hope you feel better really soon, and make a full recovery.

Well I think saying 'you should have told them about X and Y' is completely wrong.

You had being told a few years ago that you had a lesion (not a benign tumour). And that it shouldn't give you any problems. Why were yu suppose to know thta this was an important thing to say?
At 4am, in pain and bleeding??

This is A&E, not the GP surgery.

I agree that they should have asked other questions than the very specific ones they asked. They should have asked some more general questions (eg have you had any bowels problems before?) rather than the very specific ones.
I would never expect someone who is coming to A&E to be clear enough in their head to tell me all relevant information to their case (esp as they are NOT suppose to know what is relevant or not!)

Sorry missed a crucial bit of information there.
You handed them something that came from your rectum and that you had cut!?!
And they sent you back home to do some exams a week later !?!

But how did they know you hadn't perforated your bowels or something just by doing that?

"But how did they know you hadn't perforated your bowels or something just by doing that?"

^^ This.

Did you tell them you'd cut it off, or did they maybe have the impression that you'd just passed it?!

Sorry not been back on. I shouldn't have cut it off I know. It was about 4cm by 3cm, bit like a small egg. They took it away and wrote on my record it was sent for biopsy in formaldehyde. 5 days later it's reported back as a lipoma.

I told them, as they have on my record "patient cut it off" I was embarrassed but thought it important to say that. The doctor exclaimed at it as never seen anything like it.

Unfortunately when the surgeon came on ward round at 9am-ish (I had just got moved to SAU) he was surrounded by a group of bright young medical students. He didn't seem to read the message from the first doc and came straight to the bed, he didn't see the piece at all. I started explaining about the bleeding from a week previous in case he thought it was just blood from the cutting, and that I'd felt constipated and then this had happened. He interrupted and asked to have a look, asked the nurse for KY jelly and pushed the remainder of it back in- it was so painful and awful with all these watching.

Said 'it's nothing to worry about, a polyp, they sometimes prolapse like that."

Then turned to the med students saying could loop it out with flexi sigmoidoscopy.

I was so relieved to hear it seemed ok! Wasn't really though was it.

That's not just an issue with you not saying anything about a previous colonoscopy.
It's about a consultant who does read notes, and doesn't listen either. A prolapse of a polyp doesn't lead to bleeding as far as I know.
You should also have been asked about the colour of the blood.
He should also have asked you if you were happy for the students to be there (you can say NO) and explain to you what he was going to do.

DH says he did asked if ok about the students but I can't remember that. I remember he came straight in the ward to my bed, then after went to the notes and wrote in them while chatting to the students about the looping thing.

I got prescribed lactulose later and they say in the complaint response "You said you were constipated" yes I did say that and it was exactly how it felt given that it was moving through the colon into the rectum. However that doesn't mean I actually was constipated.

It's a nightmare, it seems to be as a patient you are responsible for your own outcome so much. And i was just answering whatever I was asked and look what happened!

I stopped taking the lactulose as it caused so much pain, I mentioned all this in my compliant however it is not really replied to just stated as from what the surgeon saw and did. In the response there are statements from the surgeon, and the original consultant who diagnosed me. In fact it would be very telling to compare the medical notes, my anecdote and the surgeon's to see what happened.

For example, the surgeon says 'it was difficult to examine at the bedside as it is not easy to see distinctive features'. But that was my point- if he could have seen the cut piece how would that have changed things.

Then in the same letter there's the original gastro consultant saying he wouldn't have considered removing it with a loop even when small! Aargh!

I wasn't asked if could push it back in either. It made the horrible cramps start again as my body (I now know) started to push it back out again. Just said to pass the KY jelly to the nurse. If asked I would have probably said no, as it was less painful out than in. he said something about then the faeces can pass. I had said, and it says in my notes, to the previous doc I hadn't passed faeces in a week at least and been unable to eat.

Hi NotSure yes that's the case. I guess he must have missed the bit about it being cut off?! Maybe just thought the bit left was still there. No...I checked my notes and it saws something like 'patient cut it off some remaining'

About being asked stuff over and over do you know they kept making me do this stupid list about my belongings and swabbing me for MRSA..again and again. I think that was because I went from A and E to another assessment ward then finally SAU...

Might be good if they got their priorities right and asked about em, your health rather than your baggage! Surely if they can have a checklist for that they can have one for health!