Why aren't hospitals doing their detective work?

I was talking to a doctor today about a seriously ill patient who I am keeping close tabs on, but whose medical condition is still unclear. His comments about the hospital were very telling. Here is the gist of the conversation:

I explained to this very experienced GP that this 50 year old patient had been taken to the local hospital with extreme abdominal pain some weeks ago, following two months of deterioration in health. Despite treatment by their GP with a range of different stomach acid blocking drugs, the gut pain had got much worse. Eventually they were whisked to A&E where we all hoped a detailed investigation would be undertaken.

Once in the hospital they were given morphine. A couple of hours later the doctor in charge had asked if the patient was feeling better, which they were (a known side effect of morphine I believe!) so he discharged them home. Once home the pain returned with a vengeance as the morphine wore off (surprise, surprise) and they were again in agony and again admitted to hospital.

My GP friend agreed with me that this had been a bizarre episode and added that as a GP he would send a very sick patient to hospital expecting them to do the investigative work required to ascertain the cause of the illness. Hospitals, of course, have the means to do this, with access to a broader ranger of expertise and a laboratory at hand. He was shocked that instead of doing the expected detective work it appeared that they instead found a way to free up the bed as quickly as possible. We agreed that morphine is not the answer to a seriously ill person when you have not yet ascertained the cause of their pain and obvious illness.

The medical profession really need to see themselves as medical detectives. This is, in fact, what patients expect. The fact that this is not what happens on so many occasions – and this is just one of dozens of patients I could tell you about – is, as far as I can see, not only a waste of expertise and resources but a betrayal of the public.

If a proper focus is applied to the sick patient, in endeavouring to identify the actual cause of the problem and address it at cause, sone would expect a better success rate. This is obviously a more health-effective approach, but more than that, it would surely also be more cost effective!

This patient of mine had to be admitted to hospital twice, and despite being admitted for twelve days the second occasion they managed to lose four biopsies, failed to make a meaningful diagnosis and discharged them home just as ill as when they went in. All this time and expense, and no nearer to understanding what was causing the problem. Their suffering, as you can imagine, is immense!

Of course I will do due diligence and read, think, pursue and dig for possible causes but, like most GPs, I do not have advanced diagnostic kit at my disposal. Neither am I a biochemist or specialist – we rely on our hospitals (at our peril it seems) for that level of expertise. This patient’s symptoms demand serious investigation as there is definitely more than one thing afoot here.

What is the point of someone being transferred to hospital in a seriously ill state if the required detective work is not done? What is the hospital for?

Just a few weeks ago a Care Quality Commission report stated that the health service’s failure to properly investigate hospital deaths is “a system-wide problem” that means hospitals are not learning from their mistakes and thus stopping other tragedies from occurring [The Guardian, Dec 2016]. I fear that “failure to investigate” may too often apply during admission as well.