A 40-year-old woman complained about care provided by her
general practitioner (GP). When she was 21 weeks' pregnant, she
visited her midwife for a routine check-up. The midwife found a
lump in the woman's left breast and advised her to see her general
The woman and her partner attended the consultation, and the
GP's notes recorded a three-day history of a painful lump in her
left breast. On examination there was a 3cm lump and the GP
considered that it was most likely a blocked duct with infection or
a tumour. It was his intention to refer her to a breast surgeon if
the lump did not respond to a 10-day course of antibiotics and
paracetamol, and a further appointment was made for a week later.
When they attended the second consultation, the woman advised the
GP that there had been some reduction in the size of the lump and
that it was not as sore as previously. The GP did not perform an
examination, and decided not to make a referral to a specialist
until after the birth of the baby.
The couple moved to another city later in the pregnancy, where
she told her new midwife that she had a lump in her breast. The
woman was immediately referred to the nearest breast screening
service, and was seen by a house surgeon, who recorded a fixed hard
solid lump measuring 6cm by 4cm. Following a mammography and fine
needle cytology, a diagnosis of left breast carcinoma was
After the birth of her child she underwent a left mastectomy and
axillary dissection. A CT scan confirmed likely metastatic disease
and the woman died later that year.
It was held that by not examining the patient at the second
consultation, or organising any kind of follow-up check, the GP did
not provide services with reasonable care and skill, and breached
Right 4(1). Breast cancer in pregnancy is particularly aggressive
and needs urgent management.
The GP was referred to the Director of Proceedings, who issued
proceedings before the Health Practitioners Disciplinary Tribunal.
A charge of professional misconduct was upheld.