Anyone with medical background?

[2024CUNEXTTUESDAY]

I’m not looking for medical advice. Just a confirmation of correct process. I’d appreciate help from anyone who knows what is meant to happen.

Back in December 2022 I had some pre op blood tests in my local hospital. It was just for a same day procedure but under a general. Tests done, procedure done a week later, all good.

Unbeknown to me one of the blood tests indicated an abnormality which was the start of the kidney disease I now sadly have. These results were never shared with me or my GP. My GP says it’s not their fault because the hospital or the lab didn’t share. I am waiting for the hospital to explain why they didn’t share.

I suspect they will say on its own this test wasn’t clinically significant but my kidney specialist has confirmed it was the first sign.

Thanks In advance!

Chronic kidney disease? CKD?

i would focus your time and energy on doing everything you can to protect your health and not worry about an admin issue which in reality hasn’t changed any thing.

Not a medical professional, but I've had a lot of blood tests! I don't know whether this changes across different areas, but where I am hospital blood tests would be picked up by the consultant and actioned, and once a consultant has done something with them then they would put this on the system for the GP and send out a letter (electronically these days with a hardcopy to me).The consultant can see blood tests that I've had at the GP surgery but the GP can't see blood tests that I've had that were ordered by the hospital.

I've just been through a similar situation with my son's blood results last year. I'm in Northern Ireland so the process may be slightly different but still NHS so I'll share anyway in case it's of any help.

So I put in an official complaint to my trust over this and have had many phone calls and letters from top consultants in my local children's hospital regarding wtf went wrong.

It's the responsibility of whoever "requested" the blood to relay the results back because that's who the lab returns them to. So if your GP requested the blood test (unlikely since it wasn't performed at GP surgery and GP didn't require the bloods I'm assuming) then the results go back to the them to be shared with patient. If it was a consultant who requested the blood test then that's who the results go back to and it's his/her responsibility to share them with the patient. Hopefully this can help you work out where the blame lies.

So in my son's case what happened was the lab sent the results to the wrong consultant of the hospital and that consultant saw the name of my child recognised that it wasn't a patient of hers and ignored it. So the blame lay with both the lab for human error on getting the consultant name wrong AND the consultant who should have took action when recieving results of someone that was not her patient.

I'll just add I've had lots of things go wrong as well with different conditions, and a couple of times have found that the hospital has made mistakes when I've gone for a second opinion, although mine were to do with missing things on scans rather than blood tests.. It undermines your faith in the system and whether you are being told accurate results or whether something else is going on, I got incredibly anxious about it at one point, it makes a big difference psychologically to having a doctor you feel you can trust.

Op I’m so sorry you went through this. I’ve experienced similar with a different condition. A GP failed to realise an abnormal blood result meant a particular condition was developing. I felt really frustrated and upset to realise my health could have been much better looked after.

I would recommend reaching out to AVMA the medical accident charity. They have an excellent helpline and can advise on next steps.

I am a medic, frankly impossible to say without knowing which tests were done and how far out of normal range they were.

If they were done as a pre-op work up one can only assume the Dr or nurse who ordered them saw the results and were satisfied. It is relatively easy to spot v. early signs in retrospect.

For example a Urea of 7 or 8 might just mean some one hadn't had a drink that morning. But later you can see it was the first sign. Similarly creatinine can be elevated in people with high muscle mass or in certain ethnicities.

What does your specialist say should have been done at the time ?

Did you win any compensation ?

Thanks for your reply. He said the results should’ve been flagged and I should’ve had another blood test 3 months later to see if it was a blip or a trend.

Respectfully it has changed a lot. I won’t be elaborating on that. I am focused on my health but also now need to focus on my financial future if I am unable to work.

I have nephrotic syndrome. With stage 2 damage.

I’ve had similar. I had a blood test by my GP to see why I was so tired and was told it was all ok.

about a year later I was seeing a rheumatologist who just happened to check my most recent blood test while I was there and he said it showed my kidney function was abnormal and he clearly said my GP needed to do better and I should have had a repeat test.

so went back to the gp, had the test repeated. Kidney function is still abnormal but again the gp surgery has signed it off as being ok. I can only assume even though it’s an abnormal result the gp isn’t bothered about it. 🤷‍♀️. Though Google says it could be chronic kidney disease. I keep meaning to contact the GP again and ask them do I need to do anything

I see (sort of) bit of a swiss cheese model. I expect the hospital thought the GP would follow up, but for whatever reason didn't communicate that clearly - or at all.

I suppose if you want to persue this the first thing is to get hold of your notes from the time of the first blood test.

I will be honest though if we repeated every test which was slightly outside the normal range on otherwise well patients, the phlebotomy service would be swamped. Again it depends on what was put of range and by how much.

That’s not what AVMA is about. I’ve contacted them too in the past.

HcP here. In general it's the responsibility of the clinician who ordered the tests to follow it up. It would be impossible for a GP to follow up exert blood a patient had done elsewhere. Equally, hospital bloods are generally ordered by specialist consultants and departments who are far more knowledgable in those specific areas and therefore a GP would not superceed their decision/input.

It sure looks like it from their website.

Although it is the clinician responsibility to follow up the results they ordered, a request for a 3 month re-check of something like an FBC would be wholly inappropriate for an elective surgical team to organise. It should have been reffered back to the GP. I suspect these were " routine" bloods so nothing specialist likely FBC +/- U&Es maybe a liver function test.

Happy to be corrected.

@Neurodiversitydoctor AVMA are patient safety focused. That is their mission.

I called them to get information for a relative who had a baby who now needs 24 hour care and will do lifelong.

They gave the initial info we needed on how to establish whether this was as a result of medical negligence or not. It was ultimately established by consulting an antenatal specialist that, while excellent (gold standard) practice would have avoided the situation, what had happened was at a reasonable standard and so there was no claim.

It is definitely not the GP at fault. They did not order the test so it was not their responsibility to check or follow up on it.

The hospital ordered the test for a specific reason and the test was presumably satisfactory for the reason it was ordered ie you were fit for an operation. If there was an incidental abnormal finding requiring follow up then it is on the person who ordered and checked the test to ask the GP to follow it up. Only if they asked and the GP did not carry it out is it the GPs fault.

As PP said an incidental finding of CKD is very common in such a test because U&Es are a very common test to be ordered. Usually it will resolve and even if it doesn't it commonly doesn't have a remediable cause (damage due to diabetes, vascular disease or hypertension that can't be remedied) and doesn't progress for many years. In your case it seems that it would have been helpful to have that recheck but in the vast majority of cases it would not.

Usually in our area the lab result actually comes back with a little message on about what to do at each level of CKD if it's a new finding in fact.

Thank you for sharing, that situation sound harrowing v. difficult for all involved. I think it also illustrates very clearly just how high the bar for medical negligence is.

I very much doubt a missed borderline ( I am assuming) abnormal result in a pre-op assesment will come close to that bench mark and although I accept AVMA are a charity there are unscrupulous laywers out there who will take advantage of people in a vulnerable situation.

No you’re right l, all of those and kidney function. I would’ve expected them to ask my GP to follow up rather than follow up themselves.

Thanks for the tip re the notes. I’m waiting for my complaint reply which should be in the next 2 weeks. They asked for a 2 week extension just before Christmas. But I’ll message and ask for those notes.

I absolutely agree with you about out of range results. I had low albumin, not as low as now but declining and I had other things to go with it that were indicative of a bigger issue.

I would absolutely follow up on this. Weirdly my condition was finally picked up by a rheumatologist who I was seeing for hip pain (bursitis not RA in the end ).

I attended A&E one Saturday and had a range of blood tests - ultimately discharged and advised to go to the GP. GP ordered similar bloods and when I said oh I've just had those he said he wouldn't see the hospital results as they belonged to the hospital- so needed to do them himself - seems a real lack of joined up working to me and waste of resources.
I also have repeat tests when moved departments. Conversely my consultant keeps sending GP letters with typos on my BP making it raging high and for a year they have never ever checked on it, nor done annual blood checks for my coeliac. Saw similar with my parents when I cared. This is resources perhaps.
Recently I've been referred due to an x-ray finding which same dr saw similarly on a PET scan a few months earlier but decided it could be ignored - till it couldn't.
I guess they're all human, making some decisions subjective to an extent. There is a real resource issue but what stands out to be does seem to be a real lack of comms between areas that can cause issues.
Have you tried PALS? I'm advised they can be good?

Thank. And yes I don’t think my. GP is at fault on this point, just looking to understand the process.

Thank you. That’s useful to know.

It may well be that everything was done exactly right with that particular set of test. This is what I am looking to understand.

With regards to my claim or potential claim this part is a tiny element of it. I have spent 2 years seeing specialists and my GP and in that time despite having all the symptoms none of them did a simple urine test. I’ve already been told this absolutely shouldn’t been done and my nephrologist has written to various departments advising that a presentation such as mine should always be investigated. I know I have a case, I am just making sure I have all the facts. I haven’t yet approached a solicitor.