oct ewj 24 online - Flipbook - Page 34
Failure to obtain a thorough history, partake in a
thorough examination, or even refer for an ultrasound examination and/or X-ray (radiograph) in the
first instance or even cross-sectional imaging can lead
to missed or delayed diagnosis.
in hospitals, delayed investigations in diagnostics, and
therefore, leading to ultimate delays in treatment. This
can have an inadvertent outcome with regard to treatment of the patient and subsequent increased morbidity and mortality. Any of the above reasons as
forementioned may ultimately that also will lead to
delays in treatment.
Misdiagnosis:
This may occur when the patient has had investigations, which have been incorrectly interpreted or reported. For example, an X-ray may have been
performed and a lytic lesion or suspecting bone
changes suggestive of bone cancer may have been
missed.
Metastatic bone disease and solitary bone lesion:
Metastatic bone disease is very common manifestation
of any primary cancer (commonly from breast, kidney, thyroid, lung, prostate). Management of such lesions are foremost by the Oncologist and occasionally
by orthopaedic surgeons.
The same errors can occur leading to misdiagnosis on
ultrasound scans and MRI scans with misinterpreted
imaging. Patients may present with swellings in their
trunk or limbs during a separate medical presentation
and it may not be addressed appropriately. For example causes of deep vein thrombosis (DVT) may be
due to a compressive extrinsic mass not investigated.
Sciatica can occur due to pelvic tumours. Note that
the referrer only gets the investigation report so
correlation with the patients’ clinical symptoms is an
important consideration.
The importance of such lesions is to ensure that these
are not potential new solitary lesions which could be
presenting as a primary bone sarcoma, but also to
ensure that fracture is prevented.
Inappropriate management of such lesions may lead
to: inadvertent ‘whoops’ surgery of potential bone sarcoma lesions which are presumed metastatic, fractures
in such patients without input from musculoskeletal
oncologists, or orthopaedic oncology input to occasionally resect and replace with a prosthesis or even
fix. There are now national guidelines in relation to
management of metastatic bone disease.
Delayed diagnosis/referral:
Patients in this type of category of potential delayed
diagnosis maybe those who have not been referred for
investigations or biopsy sooner. If the initial imaging
has been misinterpreted or not picked up with a
clinical history, this could be a soft tissue or bone
sarcoma/tumour, then it leads to placing referral and
subsequent diagnosis.
What is important, is that if a patient with the previous
history of cancer presents with a solitary bone lesion in
a long bone, it is important for the clinician not to assume that this is a metastatic lesion. This may be a primary bone sarcoma, and potential negligence may
occur if wrong presumption. In the instance a lesion
in the bone is inappropriately managed with surgery,
Inappropriate surgery ‘whoops’:
Inadvertent excision of a lump which turns out to be
malignant can be classed as inappropriate surgery
leading to what is commonly known in surgery as
‘whoops’. If the clinical assessment of the lump along
with the history of the patient and investigations are
not interpreted correctly, then the excision of a supposed benign lesion which turns out to be malignant
without appropriate management and discussion in
the MDT meeting, can lead to inappropriate excision
leading to poor outcomes. Ultimately, it leads to an excision leaving tumour tissue behind, which subsequently leads to further surgery requiring a wider
resection leading to inconvenience for the patient with
further surgery and potential morbidity and mortality.
This commonly occurs when clinicians do not suspect
that there could be a tumour present which leads to
patients refer to a specialist centre for recommended
management.
Mr Amit Kumar is a Consultant Orthopaedic & Oncological Surgeon.
His specialist interests are hip and knee surgery including joint replacement and knee arthroscopy along with soft tissue and bone
sarcomas. He is trained and accredited with Bond Solon and the
Cardiff University Civil Expert Certification.
Personal injury and clinical/medical negligence
(Claimant/Defendant 50:50)
Specialist areas for reports include:
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Delays in treatment:
Delays in treatment from both a surgical and oncological perspective are certainly being compounded
with the COVID-19 delays and recovery in the NHS.
Consulting venues:
Greater Manchester, Merseyside and Midlands
Medicolegal team: Beth Wild
Mobile: 07565 971396
Email: akmlreports@gmail.com
Alternate email: bw@exp-w.com
Website: www.mrkumar.co.uk
Alternate Website: www.manchesterlumpsclinic.com
As per 62-day cancer pathways following the date of
referral cancer, treatment times have always strived to
ensure that the patient is diagnosed within 31 days
from treatment in some form by 62 days.
The COVID-19 pandemic has compounded this
problem by delays with the management of referrals
EXPERT WITNESS JOURNAL
Personal injury
Road traffic accidents
Orthopaedic injuries
Hip and Knee surgery
Soft tissue lumps, tumours / sarcomas
Bone lesions, tumours / sarcomas
Metastatic Bone Disease
Delays in cancer diagnosis and surgery
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