GPs never told man of cancer in­di­ca­tors

The New Zealand Herald - - NEWS - Amy Wig­gins

Two GPs have been or­dered to apol­o­gise to a man who was not in­formed mul­ti­ple tests taken across more than a year sug­gested he might have prostate cancer.

The man went to his doc­tor com­plain­ing of uri­nary prob­lems in Novem­ber 2015 and a spe­cial­ist quickly con­firmed he had prostate cancer — but the pa­tient had not been told that the first signs of the cancer had been picked up by his doc­tors more than a year ear­lier.

In 2014 the man was seen by a locum GP at his med­i­cal cen­tre for a digital rec­tal ex­am­i­na­tion and a blood test for PSA be­cause his brother had been di­ag­nosed with di­a­betes and prostate cancer.

The PSA test re­sults came back at 7.2 mi­cro­grams per litre. The lab­o­ra­tory said the nor­mal range was up to 6.5 and about a third of cases be­tween the up­per limit and 10 re­sulted in cancer.

When the man’s usual doc­tor re­viewed the re­sults he de­cided it was prob­a­bly a be­nign pro­static hy­per­pla­sia and said he would re­peat the PSA test in six months.

The man said he was not made aware of the re­sult.

Just over six months later, a sec­ond doc­tor or­dered blood tests, in­clud­ing a PSA test.

In May 2015, the re­sults showed PSA lev­els at 10.5. The lab­o­ra­tory noted lev­els over 10 mi­cro­grams per litre sug­gested cancer was more likely than a be­nign hy­per­pla­sia and sug­gested the test be re­peated in sev­eral weeks.

The sec­ond doc­tor con­sid­ered the re­sults were bor­der­line and was not aware of the Min­istry of Health guide­line that patients be in­formed and that men aged 71-75 be re­ferred to a urol­o­gist. He doc­u­mented a re­call for an­other test in three months.

In Au­gust the man was re­called for an­other blood test but a PSA test was not men­tioned and was not done.

In Novem­ber he went to the doc­tor com­plain­ing of uri­nary prob­lems. The first doc­tor per­formed a digital rec­tal ex­am­i­na­tion and the doc­tor found the man’s prostate was slightly en­larged and nodu­lar.

The doc­tor or­dered more tests and re­ferred the man to a urol­o­gist. The Novem­ber PSA test came back show­ing a level of 15.3 mi­cro­grams per litre.

A biopsy showed the man prob­a­bly had lo­cally ad­vanced or metastatic prostate cancer.

A bone scan showed no bone dis­ease but an MRI showed the cancer had spread around his pelvis.

Health and Dis­abil­ity Com­mis­sioner An­thony Hill con­sid­ered that the first GP failed to pro­vide in­for­ma­tion a rea­son­able con­sumer, in that con­sumer’s cir­cum­stances, would ex­pect to re­ceive when he did not in­form the man of the 2014 test re­sult, its im­pli­ca­tions, and the man­age­ment plan to retest his PSA level in six months.

Hill found the sec­ond GP did not pro­vide ser­vices with rea­son­able care and skill when he failed to or­der fur­ther tests to rule out other causes for the el­e­vated 2015 PSA test re­sult, and by fail­ing to doc­u­ment rel­e­vant clin­i­cal in­for­ma­tion, in­clud­ing the reasons for or­der­ing a PSA test, his as­sess­ment of the PSA re­sult, and his plan to con­duct fur­ther PSA test­ing in three months.

Hill said the med­i­cal cen­tre also owed a duty of care to the man when man­ag­ing re­calls for fu­ture blood tests and failed to pro­vide ser­vices with rea­son­able care and skill.

He or­dered both doc­tors and the clinic to pro­vide the man with an apol­ogy and to un­der­take au­dits to en­sure pro­cesses were fol­lowed.

Hill also rec­om­mended the Med­i­cal Coun­cil of New Zealand re­view the sec­ond doc­tor’s com­pe­tence.

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