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ISRAELI PRIME MINISTER Benjamin Netanyahu took the unusual step of showing the UN General Assembly a not-very-complex diagram of a bomb to illustrate the threat of Iran’s nuclear programme.
In his speech to the UN General Assembly in New York today, Netanyahu spoke of the imminent threat of Iran’s uranium enrichment programme.
He told delegates that the country will have enough enriched uranium to build a nuclear weapon by next summer and said that a “clear red line” must be set for Iran’s nuclear drive.
“At this late hour, there is only one way to peacefully prevent Iran from getting atomic bombs and that’s by placing a clear red line on Iran’s nuclear weapons program,” he said.
“Red lines don’t lead to war, red lines prevent war.”
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It’s one thing to miss the diagnosis the first time, no testing process is perfect, but when the mistake was discovered it should be acted on immediately. Should have been 2 or 3 days not 2 or three years.
@The Bob: absolutely,
That is just horrendous. How can a Dr have that information and not act on it straight away. The “what ifs” she and her family have to live with. It shouldn’t stop people attending for smears but lessons need to be learnt.
“In modern medicine, I ask patients how much information they want, and if they want it all I print it out and give it to them there and then.”
What??? This is an excuse now for not informing patients about whether or not they have cancer?? This takes the biscuit.
@Patty Cullinane: Think you’re misinterpreting that. She was told she had cancer – after the second smear test in 2014. A diagnosis wasn’t withheld from her, in fact she was being treated when the mistake was discovered.
What she wasn’t told about was the error in the testing process dating back to 2011. Her not being told about this is what I would consider a serious breach of trust, but it’s certainly very different from withholding details about a diagnosis, as you seem to imply.
Correct me if I’m wrong on any of that.
@Patty Cullinane: How can a patient refuse information,before they receive it?
@ihcalaM: I am commenting on what Dr Coffey said. He said he has what amounts to a don’t ask, don’t tell policy. If the patients don’t ask, he doesn’t’ tell. This sounds like a half baked way to absolve what amounted to malpractice. Ms Phelan’s doctor had information for a year before she was told about the original misdiagnosis.
“Her doctor wasn’t told about her misdiagnosis dating from 2011 until 2016, and she herself wasn’t informed until a further year had passed.”
@Patty Cullinane: But you said “is this an excuse for not informing patients about whether or not they have cancer?”.
She was diagnosed with cancer. She was told she had cancer as soon as it was known.
What was withheld was information about how her cancer was missed by the US lab in 2011.
Completely different. I understand that Coffey’s comments were strange (I agree – don’t ask don’t tell is a bizarre way to run your practice) but in no way shape or form is this akin to withholding a *diagnosis* of cancer from a patient.
Very important distinction, I think. What happened was indefensible IMO – but what you were implying would’ve been 1000x worse.
@ihcalaM: it was only because she took a second smear test. If she hadn’t, she wouldn’t have found out about orignal test any differently. This begs the question…if not for the second test, would she have found out when she did? Her doctor knew information a year before telling her. But this is not what I am referring to in my original comment. Dr Coffey clearly says that if his patients don’t ask for info, he doesn’t give it. He said this in the context of Ms Phelan’s case. This leads us to believe that if a patient doesn’t't ask, he doesn’t tell….even if it is cancer. This sounds like a bad excuse for covering up a misdiagnosis. If this isn’t what he meant, then he needs to chose is words more carefully. And if it is what he meant in order to cover his arse, and common practice…we are all in trouble.
@Patty Cullinane: There’s a very big difference between witholding information about a misdiagnosis from a patient who is already being treated, and withholding information from a patient who isn’t being treated for cancer (because you haven’t told them they have it) as you let it spread.
If you’re trying to say the latter could’ve happened… I don’t know what you’re basing that on. No doctor would deliberately withold treatment from a patient for a year to save the skin of some US lab for a false negative. They’d be instantly struck off for it too.
We’re talking about something very different, as I said. This doctor probably thought they didn’t need to tell the patient immediately because it made no difference to their treatment (which I think is massively questionable, to be clear).
@ihcalaM: what if there was no audit, or if she didn’t have have the second smear test? She would not have been getting treated. And the fact remains..her doctor had information for a year that the doctor did not divulge. I don’t believe it was to save any lab’s skin. It was malpractice on the doctor’s part. It doesn’t matter that she was already getting treatment…her doctor did not fulfill his/her duty to their patient/safety. It is a breach of trust and confidence. What makes this even more likely and more clear is Dr Coffey’s response to it. This only reinforces what I said. He made an excuse to absolve the doctor. He walks a fine line that very nearly places blame on the patient for not asking.
@ihcalaM
And now Simon Harris has gone so far as to say that we can’t presume doctors have informed their patients of their smear tests, and that they pretty much have to be babysat by Cervical Check. So I am not far off the mark in my synopsis of things.
@Patty Cullinane: Agree that Coffey’s response was shocking. Don’t agree that you weren’t far off.
If there was no audit or second test, then this doctor would be the first to figure out she had cancer from the false negative… you’re saying they wouldn’t tell her? Come on. That’s massively different than what happened.
The lab made the diagnosic, medical mistake. The doctor in question, in my opinion, made a serious ethical mistake, but it wasn’t anything that had a medical impact – that’s just a fact.
I’d put my house on the fact that the doctor would’ve piped up if her health was on the line… (as I said, they would be struck off if they didn’t) the reason the MD felt they could get away with not telling her was because she was being treated already.
@ihcalaM: I don’t understand what part of this you are not digesting.
“Her doctor wasn’t told about her misdiagnosis dating from 2011 until 2016, and she herself wasn’t informed until a further year had passed.”
Her doctor had information for a year before he told her. It doesn’t matter what the circumstances are..being treated or not being treated. Her doctor failed at his/her obligation to their patient. And the fact the Dr Coffey tried to make an excuse for it just shows that there is a problem here. Medical impact or not…it was wrong. And it could have had a medical impact had she not gotten the second smear test. The doctor made a medical and ethical mistake. The doctor’s only saving grace is that his mistake did not medically impact her. What about the patients these mistakes by the doctors are impacting? Why should the doctor feel it necessary to “get away” with not telling her? Do you really not see the problem here?
“If there was no audit or second test, then this doctor would be the first to figure out she had cancer from the false negative… you’re saying they wouldn’t tell her? Come on. That’s massively different than what happened.”
How do you know? I don’t think the doctor did anything to harm the patient on purpose. I don’t think any doctor does. But the fact remains that doctors do overlook many things and do make mistakes. This doctor is an example.
I know 3 people who had cancer and did not find out until they went back to their doctors, still suffering, after receiving clear results initially. No reason for them not to be told other than laziness and unaccountability. Doctors who do this should be named so we know to go elsewhere.
@dearg doom: I had a friend, he was treated for a spider bite with antibiotics for about a year. It did not work, so the tests revealed he had a cancer an 12 months of life.
@Jindrich Marz: so the NEW tests revealed
Doctor 1: “Hey, the tests are in, this person has cancer and they don’t know about it.”
Doctor 2: “Ok, should we tell them?”
Doctor 1: “Of course!! …in 3 or 4 years of whatever.”
What situation exists where a doctor would not tell the patient about a diagnosis? I don’t understand Coffey’s comment
I think a copy of any test or exam should automatically be sent to the patient as well as their physician.
The information afterall belongs to the patient.
Scary! Dodging questions and they are allowed 3 months to inform patients. What does taxes go towards?
Truly sickening and shameful this was allowed to happen.
@Seán O’Fearain: But it is the voters choice. By voting the same parties all over again the people show their satisfaction.
My in laws dr is the same, he has been sent messages from the hospital and not acted. Only eventually when my mil attendd her diabetic appointment did the follow up on her previous diagnosis and she ended up in hospital for 5 weeks, had 3 operations. She has to go back in every 2/3 months to have the cancer scraped down. It’s palative care eventually it will kill her.
My father in law was also at the same gp he was sent home, 2 days later an ambulance was called and he was found to have pneumonia (which the gp missed) and a seperate infection. He spent 2 weeks in hospital and a further 2 in a hospice. A problem with his prostate was also identified and the hospital was mystified as to why he wasn’t referred for tests over a year ago. He is to have an operation next month, the family are terrified it’s cancer, if it is it’s bedn there a long time as symptoms have been going on for over a year.
Same gp misdiagnosed my husband, said it wasn’t cancer and it was, that was nearly 10 years ago, my husband left his care after that.
That said the same doctor saw a lump on one of my friends necks who wasn’t a patient and told her to go into his office to see him that day, she had cancer and treated promptly.
Tbh I think doctors are overloaded. They don’t have enough time to view all paperwork. So some get left at the bottom of the pile or only glimpsed at. It cost this lady her life. There should be some sort of urgent identifier on diagnosis of cancer or other serious, life threatening illnesses on lab reports to draw the doctors eye to it.
@Lily: Lily, I’m very sorry for all the things you’ve gone through. however, I have to clarify a couple of your points. regarding your father, there is potential for pneumonia to be treated at home, as doctors we follow a protocol that determines treatment plan. pneumonia can have a very quick onset as well. secondly, it wasn’t a gp who missed this result, it was a company in the US that read it wrong. thirdly, in response to the article and not your points Lily, I would be shocked if any doctor willingly denied disclosing a diagnosis to a patient. I think this is a real click bait headline taking a point out of context
@Paul Leonard:
He wasn’t given any antibiotics. For the pneumonia by gp. Even though he was complaining of a bad chest.
My daughters friends mother was diagnosed with a brain tumor after months and months of symptoms that were brushed aside as mental health issues. Only diagnosed after she collapsed at home a second time.
As I said I think the gp overlooked the results sent, because anyone seeing cancer would immediately inform the patient.
Hence my recommendation that results are marked urgent!
@Lily: Lily, you’re mis informed in this case. it wasn’t a gp, it was a consultant gynaecologist. secondly, this consultant didn’t miss the original diagnosis, it was a wrong result that was given by a lab in the US. it’s been widely reported in the press that these are the facts of this case. I won’t comment about your friend or your father because I don’t know the facts of those case. but for your information, as a doctor, if we send in tests, be they bloods, radiological exams or histology, if they’re serious results the results are passed over immediately. for example, if I do bloods on a patient and there’s something major wrong on this like the patients potassium is high or sodium is low then we’re contacted immediately by the biochemistry lab.
It really is getting worse,the poor woman and her family.
Typical half truths and sensationalism from the journal when it comes to any medical issue. My heart goes out to this lady and her family, it is an awfully sad situation. Just to clear somethings up, she settled the case against the pathology lab in Texas not the hse, she had a smear done in 2011 which was reported as clear by the lab, a repeat in 2014 showing high grade invasive carcinoma, during an audit in 2014 cervical check were informed of the false negative and for some reason didn’t let her consultant oncologist know until 2016, he/she didn’t seem to know how to proceed and didn’t get much help from cervical check who wanted he/she to explain the fu@k up, from what I can see at no point was the Gp involved, unfortunately the main issue is the miss by the US lab in 2011
@daveyt: and inaction from her oncology team, which I can understand, who wants to tell a patient in an awful situation that if somebody looking through a microscope saw the cancerous cells she probably would be fit and healthy now, no test is 100% effective and unfortunately each can be interpreted differently by different people, the only thing we can do is learn from the mistakes and try to evolve systems to minimise mistakes and their consequences which for this unfortunate patient and family are horrendous
I think most people are misterpteting the sequence of events. My understanding from reading the article is this:
In 2011 she had a smear that was reported as normal.
In 2014 it was discovered, on audit, that the 2011 smear in fact showed cancer.
In the same year (2014) she had another smear and was diagnosed with cancer – at this point she was referred to gynaecology/oncology for treatment
In 2016 her doctor was informed of the earlier missed diagnosis (from 2011).
The doctor chose not to inform the patient because by that point the diagnosis was established, she was being treated and knowing about the previous missed diagnosis was immaterial (in terms of her medical care only) at that point.
What a situation to be in, your life is in your GPs hands i think the patience should be empowered through their diagnoses being passed on to them and other intrested parties then they should be able to get a second opinion from a different testing centre to guarantee a safeguard for the patience
@James Moore: GPs hands? what are you on about?!
@Paul Leonard: have you got anything in between your ears fool read the article from the beginning of the headline.
This should be considered a criminal act.
That’s criminal
what happens in general practice in relation to cervical screening firstly the smear is obtained it is then sent by the practice to the lab within two to three weeks the result is sent to the practice via health link the client is informed on the same day in this case the lady was called for her smear in 2014 which identified cervical cancer and she was referred on from general practice at this time 2014 as is the case an audit is carried out by cervical check to look at all previous smears of clients with a diagnosis of cervical cancer it is during that process that the smear in 2011 was identified as displaying changes by 2014 this lady was undergoing treatment as a result of her smear result in 2014 there seems to be a misunderstanding on this forum that in some way the gp is responsible they are not responsible for this misdiagnosis their responsibility is carrying out the test sending it to the lab and conveying the results to the client which as I understand was done in 2011 and in 2014 that was why she was referred on in 2014 so let’s be clear the gp involved carried out their duty of care the fault lies with the lab and the audit process not the gp
Outside of the morality of this, surely there is an implied breach of contract here?
Whether or not she should be told about the missed diagnosis is a different matter.
In general yes she has a right to know, but a physician may not disclose information if (a) it is immaterial to her treatment and (b) disclosing the information may cause harm e.g. psychological distress.
Though the bar needs to be quite high for point (b) to be met.
The central problem here is the health service exists to serve the doctors, not serve the patient. This is why the apartheid of private healthcare is piggybacked on to the public health system, to line the wallets of all who get to invoice the private health insurance firms. And it will never change because if a TD proposed real change to this situation, well, he would be voted out! How dare a TD take away my entitlement to paying hundreds or thousands of Euro to jump the months long or years long waiting list for treatment that I should only have to wait weeks for at most. There is just nothing in it for politicians who want to reform the system.
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