Delayed diagnosis but no damage

A 53-year old patient with a history of a benign breast lump complained to her GP of a new lump. On examination, the GP made a working diagnosis of a benign sebaceous cyst on the chest wall. He informed the patient she could have the lump removed if she wished but reassured her it was not necessary. The patient chose not to have surgery and she was not referred.

At a routine mammogram nine months later a lump was revealed and the patient explained it had been present for a year. A biopsy confirmed it was a tumour.

The patient underwent a wide local excision of what was found to be a Grade 3 invasive ductal carcinoma. On hearing this, the GP immediately rang the patient to apologise for missing the diagnosis. He added a note about the dimensions of the tumour to the patient's records.

The patient elected to be treated with radiotherapy and tamoxifen. On review a year later, there was no evidence of recurrence of the disease.

The claim

The following year, the GP received notice of an intended claim alleging that the delayed diagnosis had resulted in the patient requiring a more extensive operation and radiotherapy thereafter, and that she had suffered psychological symptoms as a consequence.

The GP immediately rang the MDU.

The key medico-legal issue in the case was causation. Had the failure to diagnose the lump at the first consultation resulted in harm to the patient? As part of its investigations, the MDU obtained expert opinion from an oncologist. The expert agreed that had the diagnosis of cancer been made when the patient first presented to the GP, it would have made no difference to the treatment given or the patient's survival prospects. In other words, no damage had resulted to the patient from the delay in diagnosis.
 
There was also the matter of addition to the records. The MDU's advice is always that any additions should be separately dated, timed and signed. In this case, the claimant's solicitor accepted that the GP had not intended to mislead, but altering the records could have seriously weakened the defendant's case. The patient's solicitor issued proceedings, naming the MDU member as defendant. The MDU maintained a defence of causation which showed no damage. The expert oncologist reviewed the claimant's arguments and maintained his original assertion about the irrelevance of the delay in diagnosis to the patient's outcome. The following day, the claim was dropped.

Learning points

  • To succeed in a claim of clinical negligence, the claimant must prove on the balance of probabilities that:
    • The doctor owed a duty of care.
    • There has been a breach of that duty.
    • Harm followed as a result (causation). The claimant must establish whether there is a causal link between the alleged negligent act or omission and the harm that the patient claims has resulted. If there is no causal link the claim cannot succeed.
  • Records - any addition to records may weaken your defence against a claim of clinical negligence.

 

This page was correct at publication on 16/12/2010. 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.