Patient with anxiety had breasts examined, then accused of ‘drug-seeking’

A woman who went to the doctor for anxiety and with a lower rib-cage lump, had her breasts examined by a GP who later accused her of doctor-shopping and drug-seeking when she complained. Photo / Lev Dolgachov

A patient who went to the doctor for anxiety and depression had her breasts examined and when she complained the GP accused her of drug-seeking and “doctor-shopping”.

The locum GP, who has since returned to his home country, claimed the woman had mental health issues and that complaints against doctors and nurses in the region were largely because patients didn’t want to pay consultation fees.

He has now been referred to the Director of Proceedings where he could face disciplinary charges, an uncommon step by the Health and Disability Commissioner reflecting the seriousness of the doctor’s conduct.

The woman, identified as Mrs A in a report released today by Deputy Health and Disability Commissioner Deborah James, went to a medical centre operated by Te Whatu Ora on June 9, 2020, experiencing anxiety and depression related to Covid-19 restrictions.

“I was not able to communicate this to the doctor as he didn’t ask what was wrong,” the woman said in her complaint to the district health board. “He gave me a breast examination which I did not come in for...”

Mrs A said she cried during the examination in front of a nurse chaperone and told the GP, identified as Dr B, she was not visiting for a breast exam and that she did not get an opportunity to tell him about her anxiety and depression.

Clinical notes from the DHB stated the patient had found a lump under her ribcage and she was scheduled for a breast ultrasound scan the following week for a different, previously identified breast lump.

The notes also stated she had lost weight, lost her appetite, and was very anxious.

Dr B’s notes were that they discussed anxiety and he recorded she was “quite anxious” but he did not record any specific reason for the anxiety, although Mrs A disputed they discussed anxiety.

He explained to Mrs A she did not have cancer and ordered liver function tests at her request.

Deputy Health and Disability Commissioner Deborah James found the GP was unprofessional and in breach of the Code. Photo / Supplied

The woman said she left the consultation in tears and was comforted by the nurse. She went back to the medical centre the next day and saw a female GP who told her the lump was likely to be a tender joint.

At a follow-up appointment in July, Mrs A was sent to Dr B despite specifically saying she did not want to see him again and wanted to see a female doctor.

She said Dr B “grabbed the paper provided by reception out of her hands, wrote no charge and threw it back at her”, and told her to “get out and make an appointment with someone else”.

Dr B told the HDC: “[Mrs A] requested to be seen from a different GP, what I did agree on: I did not prescribe Diazepam in the first place, so my impression was if she was drug seeking again, she was doctor shopping for another GP and would say whatever to not paying the consultation fee”.

After Mrs A complained, Dr B told the HDC he had never examined a patient without their consent and that the consultation procedure had been explained to Mrs A by the triage nurse, but Mrs A didn’t know what he meant by that, and said that instead of examining and discussing with her the rib cage lump the doctor examined her breasts.

James agreed with her expert advisor that if Dr B did not confirm with Mrs A the purpose for her consultation and gain consent before proceeding with an examination, it would be a significant departure from accepted practice.

“I find on the balance of probabilities that Dr B proceeded with a breast examination without confirming the purpose of Mrs A’s visit and did not explain the rationale for the examination.”

Mrs A also rejected the suggestions she was “drug-seeking”.

“I feel [Dr B’s] ‘reasons’ for not responding to HDC’s requests are weak and show no responsibility nor recognition to the seriousness of his actions towards someone who was clearly struggling mentally.

“To label me a ‘drug-seeker’ is really disappointing coming from someone in the medical profession who should be helping not labelling.”

James said Dr B did not properly cooperate with her inquiry, hindering the investigation and delaying Mrs A’s right to a speedy and efficient resolution.

“While I acknowledge that Dr B has undergone difficult personal circumstances, throughout the HDC complaint process and investigation he has provided only brief information in response to the complaint and has made inappropriate comments about Mrs A’s general mental health.

“He has accused her of ‘[d]rug-seeking behaviour’ and made insinuations about Mrs A’s veracity by saying that she ‘would say whatever to not paying the consultation fee [sic]’ and by saying that complaints made in the region ‘were mainly because of financial reasons’.

“Dr B has failed to provide an adequate response addressing all of the issues in the complaint, despite multiple opportunities and reminders from HDC to do so.”

She found he acted unprofessionally and breached three rights in the Code of Health and Disability Services Consumers’ Rights by failing to ascertain the reason for the consultation, failing to seek and note informed consent, and failing to facilitate resolution of a complaint.

James recommended he apologise to Mrs A and undertake further training if he resumed practice in New Zealand, and referred him to the Director of Proceedings.

If the Director of Proceedings lays disciplinary charges the doctor could go before a Health Practitioners Disciplinary Tribunal and face being struck off.

Natalie Akoorie is the Open Justice deputy editor, based in Waikato and covering crime and justice nationally. Natalie first joined the Herald in 2011 and has been a journalist in New Zealand and overseas for 27 years, recently covering health, social issues, local government, and the regions.