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Follow-up of test results and appropriate referral (13HDC00599)

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(13HDC00599, 16 June 2014) 

General practitioner ~ Medical centre ~ Breast cancer ~ Metastasis ~ Follow up ~ Referral ~ Information ~ Rights 4(1), 6(1), 4(2)

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 4(2).

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.

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