Monday September 14, 2020
The Office of the Health and Disability Commissioner today released a report finding a general practitioner (GP) in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for missing an opportunity to diagnose breast cancer.
A woman in her twenties visited her GP with blood stained nipple discharge from her left breast. She had finished breastfeeding her first child six months earlier. Her GP referred the woman for an ultrasound scan, which was reassuringly normal. The GP instructed a practice nurse to contact the woman to let her know the scan was normal, and to come back if she had any concerns.
About eight months later, and two days after she had given birth to her second child, the woman came back for a further review. Her breast was rock hard and tender, and the GP prescribed antibiotics for possible mastitis (inflammation of the breast). However, the symptoms did not resolve and the GP sent an urgent request for an ultrasound scan, which confirmed a diagnosis of breast cancer. The woman sadly died three years later.
Former Commissioner Anthony Hill was critical that the GP did not refer the woman to a breast surgeon after her ultrasound scan, as required for a red flag symptom of unilateral blood-stained nipple discharge. He considered that the omission was a missed opportunity to diagnose and treat the woman’s cancer at an earlier stage.
"[T]he inescapable fact is that [the GP] should have referred [the woman] to a breast surgeon after her scan regardless of the scan results, because of the unilateral blood-stained nipple discharge, yet she did not," Mr Hill said.
"The failure to do so led to [the woman] being informed that her results were fine and that no scheduled follow-up was required, and placed the onus on [the woman] to follow up if she had further concerns, which was inadequate advice in the circumstances."
Mr Hill recommended that the GP’s medical centre conduct an audit of 10 randomly selected patients with a coded diagnosis of a breast symptom in the past year to ensure that the care undertaken is consistent with current guidance, and provide evidence of the steps it has taken to ensure a more robust safety-netting and follow-up process for high-risk patients. He also recommended that the GP apologise to the woman’s husband.
The full report for case 19HDC00988 is available on the HDC website.