Facts
On 17 October 2016, the plaintiff consulted the GP for the first time, complaining of severe leg pain. She reported her pain to be “8 out of 10”. The doctor took a history and completed a basic examination. He prescribed moderate pain relief and requested some blood tests (the First Consultation). The blood tests were normal and the results were given to the Plaintiff by the receptionist the following day. No follow up was arranged.
The second consultation occurred on 15 July 2017. The Plaintiff complained of worsening lower back and left leg pain, unexplained weight loss, lethargy and incontinence. She had undergone a CT of her lumbar spine a month earlier at the request of another GP at the practice, and it had been unremarkable. The doctor referred the Plaintiff for x-rays of her hip and knee and an ultrasound of her gluteus muscles, however the imaging revealed nothing of concern (the Second Consultation). Although a follow up MRI was suggested, the doctor did not follow this suggestion.
On 21 August 2017, the Plaintiff consulted another GP who referred her to an orthopaedic specialist, for an MRI of the lumbar spine. The MRI revealed “bony lesions – metastasis multiple”.
Further investigations were completed and on 11 September 2017, the Plaintiff received a diagnosis of osteoblastic skeletal metastases involving the sacrum, right ilium and probably neck of the left femur. Biopsies performed in mid-September confirmed a diagnosis of non-Hodgkin’s lymphoma. Her condition was terminal.
The Plaintiff alleged that the doctor failed to take steps at the First and Second Consultations which would have led to an earlier diagnosis of her condition, and that an earlier diagnosis would have improved her prognosis and life expectancy.
Outcome
The Plaintiff alleged the defendant breached his duty of care by his failure to:
- take a proper history and properly investigate the symptoms;
- perform proper and appropriate examinations;
- properly advise and treat the plaintiff;
- refer the plaintiff for investigations and plan a follow up;
- refer the plaintiff to a specialist.
Although the Court found that many of the allegations were indeed made out, it did not accept that this amounted to a breach of duty of care. The Court found that whilst there were plainly more investigations or referrals that the GP could have done at the First Consultation, the issue was whether he should have undertaken these matters, based on what a reasonably skilled GP would have done in the circumstances.
The Court accepted the defendant’s expert’s testimony that musculoskeletal pain often resolves by itself, and it was not unreasonable to expect that the Plaintiff would have returned if it did not. It was also accepted that it was reasonable not to send a new patient for numerous tests at the first consultation.
The Court stated the Second Consultation could not be seen in a vacuum, but ‘was a step in the process and not a concluded investigation or diagnosis’. The expert evidence did not establish the Plaintiff’s symptoms were such as to cause a reasonably skilled general practitioner to take different precautions. Requesting x-rays of the Plaintiff’s hip, left knee and a pelvic x-ray, and an ultrasound of her left gluteus muscles was reasonable insofar as those scans targeted areas where pain was reported. Therefore, the GP’s conduct was in accord with that of a reasonably skilled general practitioner.
Although the plaintiff’s high grade lymphoma was found to have been initially low grade lymphoma from at least October 2016 when she had her first consultation with the GP, the Court found that it would have only been detected by a PET scan at that early stage, which GPs were unable to order. Therefore, even if the GP had ordered further tests at the First Consultation, those tests would not have identified the presence of the disease.
Takeaway
Practitioners should be cautious not to misinterpret the Court’s view in relation to duty of care. Such findings are always dependent on the facts of the particular case before the court and involve analysis of the patient’s presentation at the time of each consultation. In this case, expert evidence supported the doctor’s actions by confirming musculo-skeletal complaints often resolve without intervention and it was not unreasonable for the GP to expect that the Plaintiff would return to see him if the pain did not resolve.
To read the full decision in Austen v Tran [2022] ACTSC 114 please click here.
