Big medical centres' standards questioned

The quality of care at large, branded primary health centres has been questioned after several doctors took months to diagnose the cause of a woman's symptoms.

The woman first went to the Palms Medical Centre in Palmerston North, part of the nationwide Radius franchise, in March 2007 after experiencing pain in her shoulder while gardening.

Over the next seven months, she visited the centre five more times, seeing a different doctor each time.

The pain spread to her left side, and she was suffering from weakness and numbness in both hands and shoulder, and urinary incontinence.

An MRI scan found that a cervical disc protruding into her spinal cord was responsible for the symptoms.

She underwent surgery on November 8, but continued to suffer neurological symptoms, including incontinence.

In a report by the Health and Disability Commissioner, Ron Paterson, Mrs A was quoted as saying she wanted the centre to realise it could not fob people off.

"I have gone from a fit 43-year-old woman playing sport, etc, to a 43-year-old woman who is incontinent, numb from my left arm down to the rest of my side, hyporeflexia in my left leg.

"I had to change jobs and now have no career options as I couldn't physically do the job to its full capacity.

"It has changed my whole life for the worse, financially, emotionally and physically."

Mr Paterson said after his investigation of the woman's case that her experience was a graphic illustration of what happened when a patient attended a large franchise operation where multiple doctors provided episodic care but no single doctor took overall responsibility.

"It is a reminder of the benefits for patients in having an ongoing relationship in primary care with a medical practitioner who is familiar with them and their medical history.

"One has to ask, 'Is this as good as it gets?' In my view, if this is the face of modern primary medical care in New Zealand, it is not a pretty picture," Mr Paterson said.

"It suggests that for all the fine rhetoric about quality of care and the emphasis on accreditation of systems, more work is needed to translate that into good care in practice for patients."

His report concluded that the centre failed to provide Mrs A with reasonable services and skill and failed to ensure continuity of care.

The report noted that the centre made several changes to its systems after the woman's case, including introducing a new protocol where individual patients would have one provider at the centre responsible for their overall care.