Failure to diagnose ovarian cyst

Medical history

A 27-year-old woman with a long history of abdominal pain went to see her GP complaining of tender breasts and nausea; in the event she was seen by her GP's partner. While she had menstruated three weeks earlier, this had been abnormally light. As she had continued to have small periods during the early stages of previous pregnancies, the GP felt that she might be pregnant and ordered a pregnancy test.

The patient was next seen by her own GP a few days later when he took her blood pressure after a fainting incident. The pregnancy test was negative.

Two days later the patient saw a locum GP, when she complained of intermittent bleeding and abdominal pain. He noted that she had fainted once and that her breasts were enlarged, but he could not feel anything abdominally and requested a repeat pregnancy test. The wrong bottle was used, however, which meant that the test was of no use.

The patient then saw her own GP approximately three weeks later, when it became clear what had happened with the second test. Her GP therefore requested another test, which was marked urgent. He saw the patient the next day and, because the test was negative, prescribed a progesterone to try to restart her periods. The GP examined the patient vaginally and found no abnormality. The patient had another vaginal examination and a smear the following month. Again no abnormalities were found.

Four weeks later the patient was admitted to hospital. A ruptured right ovarian cyst (8cm) was diagnosed and laparotomy was performed, during which her right ovary and Fallopian tube were removed. The patient's recovery was uneventful except for a mild urinary tract infection.

Negligence alleged

The patient made a claim for alleged negligence against her GP. She claimed that he had breached his duty of care to her by ignoring the negative pregnancy tests and failing to diagnose the ovarian cyst. She also claimed for possible reduced fertility.

Expert opinion

The MDU consulted two experts, one a GP expert and the other a consultant gynaecologist. Both felt that GP had not been negligent in his care of the patient. The consultant gynaecologist was also of the opinion that even if the patient had been referred to hospital earlier for a scan, this would probably not have had any influence on the outcome. Given the timescale, he felt that the patient would still have presented as an emergency before any results had been known. Three years after the start of proceedings the patient finally withdrew the claim.

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