GPs miss liver problems

Liver problems missed by GPs

Liver patients are failing to get the treatments they need because GPs are not ordering the proper tests.

Researchers discovered that GPs were missing a number of communicable and potentially life-threatening diseases.

Despite the GP initially spotting their problems and referring them to the hospital - many for alcoholic liver disease - they failed to follow through with further tests.

And a number were not investigated properly because the GP thought their problems were simply alcohol based.

Angry patient groups have called for a better analysis of results to stop so many liver patients slipping through the treatment net.

Nigel Hughes, chief executive of the British Liver Trust, said there needs to be changes in the system.

"Obviously the burden of increasing demand per se in primary care is not assisting practitioners in meeting the needs of every patient, but it would appear evident there is something wrong with the system, particularly I suspect the education and information provided for primary care practitioners.

Alcohol problems

"It is most unfortunate that practitioners are assuming rightfully, or wrongfully, that patients are suffering from alcohol related problems.

"Even if they are, they deserve treatment and support as required and should not be dismissed.

"This is again reinforcing a misnomer that liver disease equals alcohol dependence with no other cause, and one needs to question how good, non-judgemental clinical practice can allow this," he said

The study, by researchers from Queen's Medical Centre in Nottingham, looked at 873 patients who had an abnormal result for liver function.

Many of these were already known to hospital doctors as having liver problems.

But responsibility for keeping an eye on 157 was given back to their GPs who should have ordered further tests in the following months.

When the researchers checked over half of the patients had not received any checks.

And no patient received all the tests that the researchers thought were necessary.

Chronic conditions

Illness spotted afterwards included viral hepatitis and chronic liver disease.

And even when the tests had been carried out GPs did not always act on them - seven patients had chronic treatable liver conditions, but no treatment was arranged.

Researchers said that although the initial alcohol problems were spotted they should be followed through to exclude other liver illnesses.

"Many of the patients not investigated had been considered by their doctor, often correctly, as having alcoholic liver disease.

"It is important to note that alcoholics can have other liver diseases - for example hepatitis B and C."

Dr David Murfin, of the Royal College of General Practitioners, said the study presented an unfair picture.

He said GPs made clinical decisions about which cases should be investigated and that they saw a large number of patients and that it was not possible to reinvestigate all of these on the off chance there was a problem.

"We see many marginal results that we don't necessarily refer. If we did refer everything we would clog up the system," he said.