A doctor who missed red flags in diagnosing her patient's oesophegeal cancer has been fined more than $20,000.

The Practitioners Disciplinary Tribunal found "Dr H" had failed to refer her patient to a specialist or for an endoscopy on four separate occasions despite him presenting cancer symptoms.

The tribunal said this amounted professional misconduct and censured the doctor, a female general practitioner who has permanent name suppression, ordering her to pay 30 per cent of the tribunal costs amounting to $21,636.

Dr H has appealed the tribunal's decision to the High Court.

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Mr A, a male patient in his 50s, was having trouble swallowing, had a sore throat and pain in his chest and stomach. He had lost weight, but not deliberately.

He made an appointment at a medical centre and was allocated to see Dr H.

Mr A had four separate appointments with Dr H over a five-month period.

He reported his symptoms to her and she undertook treatment and investigations on each occasion.

However, it was not until about nine months later, when Mr A requested to see a different doctor, Dr D, who he had seen previously, that he was referred for a gastroscopy.

Mr A had been "disillusioned with the treatment he was getting... and felt there
was something more serious going on".

A month later he was diagnosed with oesophegeal cancer.

Mr A had surgery to remove the cancer and has since undergone chemotherapy and radiation treatment.

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Dr H said she accepted she had failed to properly refer Mr A to a specialist or for an endoscopy, but denied professional misconduct.

She said she became "blinkered" by her initial diagnosis that he had gastritis.

She had seen his comments about weight loss as being positive, given his earlier history of wanting to lose weight and the fact that he had been slightly overweight.

Mr A had previously consulted her about giving up smoking and lifestyle changes to reduce his weight and cholesterol.

The practitioner did not consider oesophageal cancer to be a possibility at the time as she was aware that it was a relatively rare diagnosis.

She was extremely upset for the patient, and had since done extra training, education and supervision.

However, the tribunal found Dr H had been "negligent from the outset" in not referring Mr A.

The Ministry of Health and BPAC (Best Practice Advocacy Centre) Guidelines on suspected cancer and managing dyspepsia, make it clear that referral for endoscopy or specialist advice was the appropriate course from the outset, the tribunal said.

"While failure to follow practice guidelines will not automatically amount to negligence, in this case the red flags evident made the need to act unambiguous."

A general practioner who presented as an expert witness said the patient being aged over 50, dyspepsia (pain in upper abdomen), difficulty swallowing and losing weight for months without trying were all red flags.

These ought to have prompted an "immediate referral for an endoscopy or to a specialist to exclude cancer".

"It is a basic clinical competency for a GP to know that difficulty with swallowing is
dysphagia and that it requires urgent investigation," he said.

"It is a red flag symptom because the reason for food not going down easily into the stomach is always clinically significant."

The expert said Mr A had been suffering from dyspepsia, pain or discomfort in the upper abdomen that may indicate disease of the upper gastrointestinal tract.

A patient's weight loss would not be caused by dyspepsia alone.

Losing weight without trying was an abnormal symptom that indicated disease was present and should therefore be a red flag for any GP.

The tribunal said by the fourth consultation Dr H was "clearly in a position that demanded urgent referral".

Dr H had appropriately communicated with her patient and obtained sufficient details of the symptoms from the patient, however she had failed to interpret thsoe symptoms with his age - "red flag matters that required referral".

"Dr H had asked the right questions but had failed to use the patient answers and her own observations to proper effect."