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Missed diagnosis of advanced colorectal cancer (10HDC00253)

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(10HDC00253, 15 October 2010)

General practitioner ~ Standard of care ~ Colorectal cancer ~ Missed diagnosis ~ Documentation ~ Hot key function ~ Rights 4(1), 4(2), 4(4)

A 66-year-old woman complained about the care provided to her by a GP who failed to diagnose her colorectal cancer.

Between November 2007 and November 2008 the woman consulted the GP on a number of occasions complaining of tiredness and shortness of breath. The GP diagnosed her with iron deficiency anaemia and prescribed iron supplements. Her iron levels initially improved but dropped again, and the GP prescribed more iron supplements. Her health did not improve. On two occasions in 2008, after presenting with vague upper abdominal symptoms, the GP diagnosed the woman with gastritis without carrying out any abdominal examination.

In November 2008 the woman sought a second opinion from another GP, who immediately identified a swollen liver. Following blood tests and a CT scan, the woman was diagnosed with advanced colorectal cancer.

It was held that the GP breached Rights 4(1) and 4(4) for failing to appropriately investigate and manage the woman's iron deficiency anaemia, and failing to examine the woman's abdomen prior to diagnosing gastritis.

The GP was also found in breach of Right 4(2) for failing to meet professional standards in terms of his documentation, by failing to accurately record examination findings and the activity that took place during some consultations. When recording the notes, the GP used the "hot key" function, which enables a word, phrase or list to be inserted quickly, but had not carried out the examinations as recorded.

The Commissioner recommended that the Medical Council consider whether a review of the GP's competence was warranted. The GP was referred to the Director of Proceedings. The Director decided to issue proceedings, which are pending.