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Communication of significance of PSA test, and loss of referral (08HDC06165)
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(08HDC06165, 3 October
Health clinic ~ District health board ~ General practitioner
~ PSA ~ Prostate ~ First specialist assessment ~ Urology ~ Cancer ~
Tests ~ Follow-up ~ Patient responsibility ~ Referral ~
Communication ~ Waiting times ~ Rights 4(1), 4(5),
A 70-year-old man consulted his GP at a health clinic with
urinary symptoms that suggested an enlarged prostate. As part of
his assessment, the GP performed a PSA blood test. The result of
this test was elevated, which raised suspicion of prostate cancer,
and the GP decided that a repeat PSA should be performed in three
months' time. Although the practice wrote to the man to remind him
to have this further PSA test, he did not attend for the test, and
no further attempt was made to remind him to have a repeat
A year later the man consulted the GP about blood in his urine.
A PSA test was taken and showed a higher level than the previous
year, and the man was immediately referred to a urology specialist.
Following prioritisation by a consultant urologist the referral was
received by the DHB urology service nearly three weeks later.
However, the referral was misplaced, and not actioned until the
following month. Despite being prioritised as needing to be
reviewed within four to six weeks, the waiting time was actually
four to six months, due to resource constraints. The man was
subsequently diagnosed with prostate cancer which had spread.
It was held that the clinic breached Right 6(1) in failing to
properly inform the man about the need for the PSA tests and the
results of the first test. Doctors are often quick to talk about
patient responsibility and patient compliance, but a 70-year-old
man who did not know why he needed to have a blood test, nor what
the results were, cannot be held responsible for not having a
follow-up test on the basis only of a standard form letter.
The DHB did not have an appropriate referral receipt system in
place for urology services at that time. In handling the referral,
they failed to co-operate with the man's GP to ensure continuity of
care, breaching Rights 4(1) and 4(5). It was also held that the man
was provided with misleading information about the expected wait
for a first specialist assessment appointment. Accordingly, the DHB
breached Right 6(1)(c).