Health and Disability Commissioner Morag McDowell today released a report finding a general practitioner (GP) in breach
of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in the care of a woman who
presented with a respiratory complaint.
The woman, aged in her sixties at the time of events, had a history of asthma. She saw her GP after becoming unwell with
symptoms of a tight chest, sore throat, and upset stomach.
The GP prescribed the woman with prednisone, a steroid medication, at a dosage of 80mg a day for a week, to be reduced
to 40mg a day for another week. However, the woman remained unwell, and the GP extended the length of time she was to
take the medication. Following this consultation, the woman began taking 100mg of prednisone a day, believing this to be
the GP’s instruction. However, the GP stated that this was not his instruction. The GP saw the woman again after having
been told by the medical centre’s practice nurse that she was taking 100mg of prednisone daily. He said that he advised
her to reduce the dosage. However, the woman stated that she did not begin reducing her dosage until a GP friend later
advised her to do so.
Health and Disability Commissioner Morag McDowell found a number of failures in the care provided by the GP to the
woman. These included commencing the woman on a higher than recommended dose of prednisone, failing to measure and
record her peak expiratory flow rate, inadequate documentation for his consultations with the woman, and failing to take
sufficient care with a prescription.
"[T]hat there was such a divergence in the parties’ understanding of what [the GP] advised [the woman] highlights the
need for clear instructions. … [C]lear instructions are vitally important when a medication regimen is at all
complicated, and [the GP] should have documented what he told [the woman] about her prednisone dosage."
The GP is now overseas. Ms McDowell recommended that should he return to New Zealand, he should undertake a clinical
notes audit and review the New Zealand Asthma Guidelines, and report back on any changes made to his practice as a
result. She also recommended that the GP provide a written apology to the woman, and that the Medical Council consider
whether a review of his competency is warranted.
Ms McDowell also noted that the New Zealand Formulary (an independent resource that provides clinically validated
medicines information for health professionals) provides refined information with respect to steroid use for specific
conditions (including asthma), and that this advice is consistent with the New Zealand Asthma Guidelines. The
Commissioner encouraged clinicians to use the New Zealand Formulary for accessing up-to-date prescribing information.
To read the full report on case 19HDC01826, visit the HDC website.