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Missed diagnosis of lung cancer (10HDC00610)
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(10HDC00610, 29 February
Medical officer ~ Standard of care ~ Lung cancer ~ Missed
diagnosis ~ Clinical examination ~ Record keeping ~ Rights 4(1),
A 52-year-old woman with an extensive history of smoking and a
family history of lung cancer presented to her doctor on multiple
occasions between June 2008 and February 2010 with complaints of
persistent coughing, chest and throat pain, fever and sweating,
haemoptysis (coughing up blood), and shortness of breath. The woman
also had a long standing benzodiazepine dependency.
Over the 20-month period, the doctor diagnosed the woman with
respiratory tract infections and acute pharyngitis and prescribed
the woman antibiotics and cough medicine. During that period, the
doctor did not physically examine the woman or take any steps to
investigate her respiratory symptoms.
The doctor's notes were, in places, illegible and incomplete and
did not comprehensively and accurately document the woman's
symptoms of persistent coughing and chest and throat pain, or what
examinations, if any, were undertaken. Moreover, the doctor's
computer and handwritten notes were not adequately integrated.
In February 2010, the woman was taken to hospital suffering from
severe chest pain. A chest X-ray revealed a large mass in the
woman's lower right lung and she was diagnosed with primary lung
cancer with extensive metastases in the liver, lung and
mediastinum. The woman was referred to palliative care and died a
few months later.
It was held that, at the very least, the doctor should have
physically examined the woman and referred her for an urgent chest
X-ray in May 2009. By failing to do so, the doctor breached Rights
4(1) and 4(4). The doctor should have been capable of managing the
woman's drug dependency without overlooking the clear need to
investigate the woman's respiratory symptoms. The doctor also
breached Right 4(2) as his documentation did not meet professional
The doctor no longer holds a current practising certificate.
However, should he decide to return to practice in the future, the
doctor was recommended to first familiarise himself with relevant
guidelines and undergo additional training on clinical
documentation. It was also recommended that the Medical Council
undertake a competency review of the doctor before issuing him a
new practising certificate.
He was referred to the Director of Proceedings, who decided not
to issue proceedings.