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A doctor who failed to diagnose a woman's lung cancer and made her feel "like a piece of rubbish'' has been found guilty of breaching her rights.
Ms A was 52 and had smoked about 50 cigarettes a day for more than 20 years, as well as being addicted to benzodiazepine, a Health and Disability Commissioner's (HDC) finding released today said.
She repeatedly went to Dr B between June 2008 and February 2010 with persistent coughing, chest and throat pain, fever and sweating and shortness of breath. She was also, at times, coughing up blood.
Dr B diagnosed her with respiratory tract infections and acute inflammation of the throat or pharynx but never performed a physical examination or referred her for an x-ray, despite her having a family history of lung cancer.
Ms A called Healthline in unbearable pain on February 27, 2010 - having seen Dr B earlier that day - and an ambulance was called.
She was taken to hospital where a chest x-ray revealed a large mass in her right lung, with a CT scan and lung biopsy confirming she had lung cancer which had spread to her liver.
"The hospital has told me that my cancer is so far advanced that I have a few months to live. Tests were not required to come to this diagnosis, they only needed to feel the swelling of my liver,'' she told the HDC.
"If my GP had taken the time to examine me, refer me for tests or listened to what my concerns were, I may have been in the position where I could have had treatment.''
Instead, he had made her feel like "a piece of rubbish to be tossed into the rubbish bin'' and had told her she was a "drug dependent piece of rubbish'', she said.
She had tried to find another doctor but they all said they were not taking new patients once they knew of her drug dependency and, in any case, Dr B was the only one she could afford.
She believed he did not want to examine her "because I was dirty in his eyes, and he couldn't stand to touch me''.
Ms A was referred for palliative care after her diagnosis and died a few months later.
Dr B told the HDC he was not aware of Ms A's family history of lung cancer and did not recall her asking for an x-ray or telling him her chest pain and coughing were persistent.
He disputed he had "failed'' to order a chest x-ray for her but accepted he did not do so.
"He advised that if Ms A had been persistently coughing blood he would have considered a chest x-ray to be 'mandatory','' the report said.
"However, as she had 'such a short history' of the symptom, which he believed was only of five days' duration, he decided that he would wait one week before considering whether an x-ray was appropriate.''
However, on reflection, he accepted there "could'' be merit in routine chest examination for all Maori over 45 years with a 25 year-plus history of smoking.
The HDC's clinical advisor, Dr David Maplesden, said Ms A should have been referred for a chest x-ray as early as June 2008.
"Dr Maplesden advised that there is no indication that Dr B took 'anything other than an episodic approach without investigation or follow-up' to manage Ms A's symptoms.
"Her late diagnosis of lung cancer was a 'direct result of the failure by [Dr B] to consider this diagnosis in a patient at significant risk and with a suspicious presentation in a timely manner'.''
The HDC found Dr B failed to discharged his duty of care to Ms A, and that his failure to get the basics right compromised her safety and wellbeing.
Dr B has since retired and does not hold a practising certificate. The HDC recommended that, should be want to practice again, he undergo further training, reorganise his medical records and familiarise himself with the publication Suspected Cancer in Primary Care.