A reasonable diagnosis

The scene

On examination, the member diagnosed a cyst and found nothing that would indicate the lump was cancerous. However, he asked her to return to be reviewed in six weeks' time. When the patient returned for her review, the lump had increased to the size of a pea.

The GP was sufficiently concerned about the change that he referred her to hospital. She was seen at the hospital a month later, was investigated, and it was thought that the lump was a fibroadenoma.

A fine needle aspiration showed the lump was suspicious but probably benign and the patient was admitted for biopsy of what was still thought to be a benign tumour.

Unfortunately, histology proved the lump to be a carcinoma. As it had been incompletely excised, the patient was readmitted for definitive surgical treatment for breast cancer, some five months after her original GP consultation. She was advised subsequently to have radiotherapy to the breast and cytotoxic chemotherapy.

When she learned that she had cancer, the patient complained that she should have been referred to the hospital by her GP immediately, rather than six weeks after her original GP consultation, and brought a claim against the doctor.

The outcome

The MDU obtained a GP expert opinion on the standard of care provided by our member. The expert was asked to comment in particular on whether the delay in referring the patient to hospital was in any way unreasonable. The expert stressed that it is not uncommon for a patient to have a lump in the breast which has all the indications of being benign clinically.
 
The key factor in the case was whether a responsible body of GPs would have suspected breast cancer in a 28-year old woman. The Bolam judgement of 1957 established that a doctor is not negligent if he or she acts in accordance with a responsible body of medical opinion in his or her specialty at the relevant time, even if there is another responsible body of opinion that takes a different view or adopts a different approach. At any one time there may be several responsible bodies of opinion in a particular field or area of expertise.

The MDU's expert felt that in this instance our GP member's initial diagnosis of a cyst was entirely reasonable. He pointed out that breast cancer in a woman of 28 years old is extremely uncommon and that therefore the doctor's index of suspicion about a diagnosis of cancer is always lower than it might be if the patient were, for example, 40 years of age or older.

He also pointed out that the six weeks that elapsed between the initial diagnosis of the cyst and the patient's referral to hospital would have been unlikely to have affected the outcome for the patient.

The MDU refuted in the strongest possible terms that our member had in any way been negligent, and this view was amply backed up by the testament of our GP expert. The claimant's solicitors decided to drop the case.

This page was correct at publication on 17/12/2010. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.