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Follow-up of test results and appropriate referral (13HDC00599)
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(13HDC00599, 16 June
General practitioner ~ Medical centre ~ Breast cancer ~
Metastasis ~ Follow up ~ Referral ~ Information ~ Rights 4(1),
A 57 year-old woman attended a consultation with her general
practitioner (GP). She had previously been diagnosed with and
treated for breast cancer. She told the GP that she had been
experiencing pain and reduced movement in her left shoulder. The GP
referred her for an X-ray and ultrasound.
The GP received and reviewed the woman's imaging report in which
the specialist radiologist had commented that a full thickness tear
of the tendon was evident, and that the appearance was highly
suggestive of metastasis. A bone scan and review by an oncologist
was strongly recommended. After reviewing the imaging report the GP
arranged to see the woman later that day. However, at the
appointment the GP did not discuss with her the possibility of
metastasis referred to in the radiologist's report, instead only
discussing the tendon tear.
The GP referred the woman to an orthopaedic surgeon for a review
of her left shoulder problems. The referral letter made no mention
of the possibility of metastasis being present, and referred to the
woman's previous breast cancer only briefly.
An orthopaedic surgeon subsequently diagnosed the woman as
having a metastatic lesion in her left shoulder, likely of breast
origin given her medical history. Sadly, despite an extended period
of active treatment, the woman died.
It was held that the GP did not arrange adequate timely
follow-up in response to the imaging report received and
accordingly breached Right 4(1). Further, the GP failed to discuss
the scan results with the woman and the possibility of metastatic
disease as indicated in the imaging results, thereby breaching
Right 6(1). The referral letter that the GP sent was also not of an
appropriate standard, and accordingly, the GP breached Right
Adverse comment was also made about the medical centre where the
GP practiced. The GP was referred to the Director of Proceedings,
who decided to take no further action.