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Follow-up of abnormal PSA tests (10HDC01250)

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Medical practitioner in general practice ~ Medical centre ~ PSA ~ Prostate ~ Cancer ~ Follow-up ~ Communication ~ Documentation ~ Patient Responsibility ~ Rights 4(1), 4(2), 4(5)

A 67-year-old man complained that a doctor working in general practice did not advise him that his PSA tests had been abnormal for a number of years. The man had a family history of prostate cancer and an enlarged prostate. The man requested regular PSA tests from the doctor's medical centre.

The man's PSA levels were within the normal range until November 2006, when he developed urinary retention and prostatitis and was seen in a hospital emergency department. Following this the man self-referred to a urologist, whom he saw once in 2006. The urologist did not write to the man's doctor because he expected the man to return for a follow-up visit a few days later, but the man did not return. Over the next few years, the man gave the impression to the doctor and other providers involved in his care that he was under the care of the urologist, when this was not the case.

From May 2008, the man's PSA results were slightly abnormal and from February 2009 they trended upwards. The doctor asked the man to request a report from the urologist but did not copy the PSA results to the urologist, offer to perform a digital rectal examination (DRE), or contact the urologist directly.

In February 2010, a locum working at the medical centre referred the man to the urologist. The man had further tests, which confirmed he had prostate cancer.

It was held that the doctor breached Right 4(1) by failing to have a recall system to ensure systematic PSA testing and review of the results, failing to discuss the man's treatment with him directly, failing to offer to perform a DRE, and failing to make specific enquiries about the extent of the urologist's involvement. The doctor's documentation of the man's care departed from expected professional standards and breached Right 4(2). It was also held that the doctor breached Right 4(5) for not copying the man's test results to the urologist and failing to gain the man's consent to contact the urologist.

The medical centre was found not to have breached the Code.

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