Follow-up of abnormal PSA tests.

A 67 year old man had a family history of prostate cancer and an enlarged prostate. The man requested regular PSA tests from his doctor’s medical centre. The Health and Disability Commissioner investigated a complaint from the man that his doctor did not advise him that his PSA tests had been abnormal for a number of years.

The man’s PSA levels were within the normal range until November 2006, when he self-referred to a urologist after being seen in a hospital emergency department. The urologist did not write to the man’s doctor because he expected the man to return for a follow-up visit a few days later, but the man did not return. Over the next few years, the man gave the impression to the doctor and other providers involved in his care that he was under the care of the urologist, when this was not the case.

From May 2008, the man’s PSA results were slightly abnormal and from February 2009 they trended upwards. The doctor asked the man to request a report from the urologist but did not copy the PSA results to the urologist, offer to perform a digital rectal examination (DRE), or contact the urologist directly. In February 2010, a locum working at the medical centre referred the man to the urologist. The man had further tests, which confirmed he had prostate cancer.

The Commissioner, Anthony Hill, found that the doctor breached the Code of Health and Disability Services Consumers’ Rights in several respects. The doctor did not have a recall system in place to ensure systematic PSA testing and review of the results, and did not discuss the man’s treatment with him directly, offer to perform a DRE or make specific enquiries about the extent of the urologist’s involvement. Furthermore, the doctor failed to copy the man’s test results to the urologist and did not obtain the man’s consent to contact the urologist to ensure his rising PSA levels were being appropriately managed, and therefore failed to ensure that the man received quality and continuity of services.

The doctor also failed to complete comprehensive clinical notes of the man’s care.

The medical centre was found not to have breached the Code.

Featured image by prostrate.org.nz

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