ANALYSIS:Recurrent misdiagnosis problems stem from a lack of centres which enable multidisciplinary teamwork, writes DR MUIRIS HOUSTONMedical Correspondent
THE CASE of Edel Kelly, the 26-year-old woman from Co Clare who appears to have been yet another victim of cancer misdiagnosis, is primarily the result of her not being assessed at a specialist cancer centre.
Ms Kelly was initially referred to Ennis general hospital after she discovered a breast lump. Ideally, she would have been assessed in a fully functioning multidisciplinary breast cancer unit. However, Ennis does not have this facility; under the cancer control programme currently being implemented by Prof Tom Keane, Ms Kelly would be referred to Limerick or Galway for triple assessment.
Multidisciplinary team working (MDT) and triple assessment are key elements in bringing down the death rate from breast cancer. The triple assessment of a breast lump in a dedicated clinic means that a woman will undergo radiology (usually a mammogram), examination by a specialist breast surgeon and a biopsy of the lump which will be examined by a pathologist specially trained in breast pathology. Clinics offering triple assessment aim to carry out all elements of the assessment at a single visit.
A key factor in good cancer care is to have all health professionals involved in a woman's care located in one place, enabling multidisciplinary teamwork to take place. At the centre of this concept is the holding of a weekly conference of all staff at which both the diagnosis and the future treatment of the patient are discussed. Every detail of the patient's case is up for discussion, from the GP's referral letter to the pathologist's report.
But some cases can be difficult to call. For example, the mammogram and the biopsy may be negative, but the surgeon and/or the radiologist will still be concerned about the nature or consistency of the breast lump. In these cases a multidisciplinary approach really helps.
MDT allows the lone voice of concern to be heard. By giving a value to a minority view it frequently triggers a decision to re-test or re-examine the woman involved. And it is this process that essentially makes it less likely that a woman with breast cancer will be misdiagnosed.
In Ms Kelly's case, the concern of the consultant pathologist, who asked for further "clinical correlation" even though the biopsy was negative for cancer, would have been discussed at a weekly MDT meeting, leading, in all likelihood, to further investigation.
But another factor is also relevant in this case. It concerns the appropriate handling of information and reports at Ennis general hospital. Test results must never be filed without being signed off as either normal or requiring further specified action. So the question arises: was the request for "clinical correlation" from the Limerick pathologist considered by staff at Ennis?
This aspect of Ms Kelly's care echoes the recent case of Ann Moriarty, also treated at Ennis general, where test results suggesting a recurrence of her cancer did not appear to have been acted on. An external review of how Ennis general hospital processes important patient information is now required.