A man had his teeth and half his lung removed due to a GP’s mismanagement of a cancerous lump on his neck, according to a report from the Deputy Health and Disability Commissioner released today.
The report outlines whether the standard of care provided by the GP and the medical centre was appropriate during two appointments in 2021.
The man attended his first appointment for review of a lump in his neck that had been present for about a year but was increasing in size and had become more tender over the past three months.
He also had trouble swallowing liquids.
The GP, in her first week of employment in New Zealand after practising overseas, said that her impression was that the lump was an “enlarged lymph node” and elected to treat it with anti-inflammatory medication for two to four weeks.
She advised that the man notify her if his symptoms worsened, and to return for a follow-up review in four weeks’ time.
The man did not make this follow-up appointment.
Six months later, the man returned to the medical centre for a second appointment, reporting a sore tooth that had been pushing on his gum for around one month. The GP recorded that his neck lump was ‘still there, [h]asn’t really changed’ and that his ‘submandibular gland [was] unchanged’.
She acknowledged that the man’s dental infection was a “distracting factor”, and that “it would have been prudent for her to have arranged further evaluation of [the man’s] neck lump at this appointment".
The man in his fifties was diagnosed with adenoid cystic carcinoma, a rare cancer of the salivary gland, and given three to five years to live as of June 2022.
Just under a year later, the man emailed the medical centre to advise his diagnosis of adenoid cystic carcinoma overseas, and that he was due to have surgery within three weeks.
His specialist team told him the two surgeries to remove his teeth and half his lung could have been avoided with earlier intervention.
He referred to his appointments with the GP and said that she had told him his neck lump was related to his teeth and it could not be cancerous because it was sore.
A formal reply from the medical centre following an investigation contained a letter from the GP outlining her examinations and assessments.
It also included an apology that the care he received in 2021 “did not lead to a more expedient diagnosis and treatment”.
Official's Response
Deputy Heath and Disability Commissioner Vanessa Caldwell found that the GP breached the Code by failing to refer the man for specialist review and/or investigations of his neck lump in line with accepted practice and clinical guidelines.
"Although the man’s cancer is a rare, slow-growing type, which often hinders early diagnosis, his neck lump was persistent and significant in size, with no clear cause at either appointment.
"There were two missed opportunities to diagnose his cancer at an earlier stage."
The Deputy Commissioner did not find any breach of the Code by the medical centre in terms of the GP’s induction, orientation and initial supervision.
The Deputy Commissioner recommended the GP audit her assessments of 20 patients presenting with unexplained lumps, masses or lesions and report back on whether the audit showed appropriate steps were taken in each case.
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