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Assessment of patient presenting with weight gain and abdominal discomfort, later diagnosed with large ovarian cyst (04HDC08095)

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(04HDC08095, 2 March 2005)

General practitioner ~ Abdominal symptoms ~ Ovarian cyst ~ Diagnosis ~ Threshold for suspicion ~ Examination ~ Investigation ~ History-taking ~ Record-keeping ~ ACC ~ Standard of care ~ Professional and ethical standards ~ Rights 4(1), 4(2)

A woman complained that her general practitioner failed to adequately investigate and appropriately treat her abdominal symptoms. The woman, who had a history of gastric trouble, initially visited her doctor complaining of bloating and abdominal discomfort. He examined her and commenced treatment for dyspepsia (indigestion) and dysmotility (abnormal digestion process). Over the next eight months, the woman visited the doctor on three occasions. On each occasion, the woman says she mentioned the worsening discomfort and that she was gaining weight in an unusual form and for no apparent reason.

Three months later, the woman visited the doctor as her abdominal symptoms were giving her increasing cause for concern. The doctor prescribed her an appetite suppressant without physically examining her.

There were a further two appointments over the following four months, at which the woman claimed her main concerns were the increasing pain and discomfort caused by her distended abdomen. Sixteen months after she first went to her doctor complaining of bloating and abdominal discomfort, she was admitted urgently to hospital, where it was discovered she had a 14.7kg ovarian cyst.

It was held that in failing to discharge his duty of care in adequately and appropriately assessing the woman, the doctor breached Rights 4(1) and 4(2).

The general practitioner was referred to the Director of Proceedings, who issued proceedings before the Health Practitioners Disciplinary Tribunal, and a charge of professional misconduct was upheld.