The claim

The patient's husband brought a claim against the GP, alleging they should have carried out a rectal examination and referred the patient for further investigations at her initial consultations. The claim further alleged that if this had been done, the rectal carcinoma would have been diagnosed and the patient, on the balance of probabilities, would have survived.

The MDU obtained independent expert evidence from a GP, who was supportive of the member's management at both of the consultations in question. The expert noted that symptoms of haemorrhoids are common in pregnancy, and that the majority of competent GPs would provide symptomatic treatment and avoid rectal examination in pregnant women unless absolutely necessary. The expert GP's view was that there was no indication for further investigation at any point before the patient was referred.

The MDU's claims handler also obtained expert evidence on causation from an oncologist. She noted that colorectal carcinoma in the 25-30 age group is extremely rare, with on average fewer than 80 women in this age range diagnosed annually.

The patient had an extremely rare subtype of tumour characterised by early infiltration of the submucosa, making diagnosis difficult and conferring a very poor prognosis with early metastatic spread. The tumour was not easy to detect on digital rectal examination until very late in the course of the disease. It was not found by the first consultant surgeon either, and as such even if the GP had examined early on, an obvious rectal carcinoma would not have been palpable.

Furthermore, the cancer was likely to have been present two years before the patient presented; even if she had been referred at the first consultation, the tumour would not have been diagnosed before it metastasised and the outcome would have been the same.

Alleged delayed diagnosis of rectal cancer

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Alleged delayed diagnosis of rectal cancer