The Deputy Health and Disability Commissioner has found a general practitioner (GP) in breach of the Consumers' Rights code after he delayed advising his patient of his prostate cancer results.
The HDC report found the GP had delayed in advising the patient of his prostate-specific antigen (PSA) test results in 2017. The 60-year-old man, who is also the GP's relative, went on to develop prostate cancer.
HDC Deputy Commissioner Deborah James found the GP breached Right 4(1) of the Code, concerning the right to services provided with reasonable care and skill.
The patient told the HDC that he initially went to see the GP with a throbbing vein in his upper left leg, an uncomfortable perineum and a low libido. He told the GP that as a man in his sixties with a family history of prostate cancer, he was concerned with the symptoms.
The patient underwent routine screening blood tests, which indicated that he had a raised prostate-specific antigen (PSA) level - results that he should have been informed of.
However, the GP decided he did not want to inform his patient of the results as the patient claimed he was experiencing a "hypertensive crisis".
He felt that if he were to follow the protocol and ask the patient to come into the practice to discuss the PSA result, it would have "caused more harm", with a significant rise in blood pressure and possibly a stroke or heart attack.
The GP told HDC that he wanted to inform the man of the results once his blood pressure was under control, however, the patient said he did not believe such information would have overloaded him with stress, but rather galvanised him to take action immediately.
James found the GP did not take appropriate action following receipt of the man's abnormal test result and his management of the results was not consistent with Ministry of Health guidelines.
James found that the GP also breached Right 6(1); the right to information that a reasonable person would expect to receive in those circumstances, for failing to inform the man of the abnormal test within a reasonable time.
The man visited his GP several times over the next three years for ongoing symptoms however the GP still did not advise him of his PSA result at any time during these visits. In 2020, a repeat PSA test was taken and the man was diagnosed with metastatic prostate cancer.
James was also critical of the GP treating a relative and the way he dealt with patient test results.
She recommended the GP undertake self-learning on the importance of sharing test results, audit current policies at his practice to ensure they are appropriate in light of her finding and to reflect on how treating a relative may have affected his care.
The GP has put in place several changes to his practice following this report including:
- Implementing a prostate screening policy to achieve the Royal New Zealand College of General Practitioners standard
- Attending teaching by a urologist to improve his knowledge and practice
- Improving his patient recall administration processes
- Undertaking a learning module on a prostate cancer testing decision support tool
- Implementing a patient portal so patients can see their results and other information.
The HDC also recommended that the GP provide a written apology to the man and recommended the Medical Council of New Zealand consider a review of the GP's competence.
