At the colonoscopy not detecting the abnormal area in my bowel
I believe that when the bleeding started this was from a cancer developing in my Bowel. At the colonoscopy that Mr A carried out I feel that if he didn't find an obviously suspect area that he should have investigated it further because I was reporting this random bleeding. I had clearly reported this bleeding in the pre-assessment interview before the colonoscopy. I had stated that this bleeding had only started recently. If he could not see the source of the bleeding and was assuming that this was the haemorrhoids he should have had the haemorrhoids treated so that these could be ruled out. If the bleeding continued then further investigation was needed to find the source of the bleeding.
Incorrect - Diagnosis of PE’s
After the diagnosis of lung PE’S - but with pains that did not seem typical of PE pain - then this being followed by deterioration and pains in different places. I feel they should have been able to cast doubt on the PE diagnosis and re-examine the symptoms. However because this diagnosis had been made they seemed blinkered and the symptoms were made to fit with this PE diagnosis rather than looking at the evidence from a fresh assessment. After all the VQ scan just showed that blood was not getting to all parts of the lungs. It does not mean that it is definitely clots that are causing this. It could be cancerous lesions (as it was)
Poor systems that cause delays
Because other consultants or other departments need to be contacted to ask for appointments delays are caused.
Examples:
When Dr B decided on 16/01/09 that an appointment was required with Mr A to deal with the haemorrhoid/ bleeding problem a letter needed to be prepared and sent to Mr A so I got an appointment on 11/2/09. This is a huge delay of nearly a month. Also, because my hospital notes needed to be sent to Mr A, Dr B was not able to consult them for my condition and other tests he got done.
When a heart ultrasound was requested from the ECG department on 16th January I got the appointment on 3/2/09.
The CT scan was requested on 30/01/09 and carried out on 12/02/09.
Reluctance to use CT scans
There seems to be a reluctance to get CT scans carried out but they provide so much detail and information that a diagnosis is much more reliable.
When Mr A carried out the colonoscopy and did not report a suspicious area in my bowel, if a CT scan had been carried out it may well have shown this thickening area, especially if it was compared to a previous CT scan. I could have had a biopsy taken and the infected area removed, given a stoma with a bag and I would have been fine as it wouldn’t have had the chance to spread.
Had a CT scan been carried out instead of the VQ scan (which was used to diagnose clots) the clots could have been counted. This seems to be common practice in the U.S. Then when I continued to have symptoms that did not seem like standard clots, if another CT scan was carried out this would have shown whether the clots had dissolved. If they hadn’t dissolved the diagnosis of clots would have been suspicious. A further CT scan could have been carried out on my bowel which would have showed the abnormal area and at that point more treatment options could have been available.
It seems to be that a combination of cheap tests are used to try to prove a diagnosis rather than use CT scans early on where they can really produce a result and pick up things that might not even be related to the current symptoms. I appreciate that it is probably funding that promotes this method. But it may be cheaper in the long run to have a CT scan early on, avoid some of the cost of some tests but reach a more reliable diagnosis rather than making a diagnosis and then when things don’t seem to be working out then having a CT scan months down the line of just one treatment.
I discussed this with Dr B. He said a CT scan gives about 200 times the radiation of a standard x-ray. They are reluctant to use them because of this and using them early is not in the treatment path. He said that they can be a problem for young people who have not had a family. In my case sterilisation is not an issue and if asked I would have rather have had a more accurate diagnosis.