Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

The Director of Proceedings (the DP) charged that Dr Murray George Wiggins was guilty of conduct unbecoming a medical practitioner and that conduct reflected adversely on his fitness to practise medicine. The DP charged that between 28 January 1999 and 5 March 1999 while providing medical services to his patient, he:

1. failed to consider breast cancer as a differential diagnosis
   OR
2. considered breast cancer as a differential diagnosis but failed to take appropriate steps to confirm or exclude the differential diagnosis of breast cancer.
   AND/OR
3. failed to appreciate the significance of the number of consultations with his patient between 28 January 1999 and 5 March 1999.
   AND/OR
4. failed to appreciate the negative effect his communication manner had on his patient.
   AND
5. failed to provide an atmosphere that enabled both his patient and him to communicate openly, honestly and effectively.
   AND/OR
6. communicated in a manner that caused his patient to feel unheard by him and/or to feel that he thought she was a hypochondriac.

Background: 

The patient and other female members of her family had experienced lumps in their breasts over a number of years. In 1992 the patient was referred to a hospital to investigate discomfort in her left breast, which was accompanied by a small nodule in her armpit. The surgeon who examined her did not find any cause for concern.

On 28 January the patient went to Dr Wiggins' practice. Dr Wiggins was not there and the patient saw Dr Wiggins' locum. The patient complained of tender swelling in her left breast, and explained that it had been troubling her for two months. Dr Wiggins' locum wrote a letter of referral to the hospital.

On 9 February the patient went back to Dr Wiggins' practice. She had pain in the front left of her chest, left upper back and left shoulder and she considered it might be related to her breast swelling and a lump in her armpit. The patient had made inquiries at the hospital but had not been able to speed up her visit so she went to see Dr Wiggins as an alternative. He prescribed voltaren as he thought that she had some musculoskelatal problem. He felt the lump under her arms but he was not concerned.

The third visit to Dr Wiggins' practice was on 23 February 1999. The patient was still in pain and the pain had extended to her right shoulder. Dr Wiggins examined the patient's breasts and upper body. He detected tenderness but no significant abnormality in the breast. He prescribed more pain relief and arranged for the patient to have a blood test. The blood test result was consistent with a rheumatological problem. On 1 March Dr Wiggins referred the patient to a rheumatologist.

The patient's pain continued to get worse and she had difficulty coping with her work. On the evening of 4 March 1999 the patient telephoned her sister and they spoke for a long time. There was no doubt the patient was feeling quite desperate by this time.

The patient went to see Dr Wiggins the next day, 5 March 1999. At that consultation the patient was distressed, and in pain. Her impression of that consultation was that Dr Wiggins treated her as though she were a hypochondriac and discouraged her from returning until the 14th of the month. Dr Wiggins prescribed diazepam as a muscle relaxant and prednisone.

Later that day, after taking the diazepam and prednisone, the patient was very unwell, and was transported to hospital by ambulance. When the patient got to hospital she was examined and a chest x-ray was taken. As a result, the patient was diagnosed as having a pleural effusion. After further investigation and surgery the diagnosis was made of breast cancer that had developed secondary malignancy, affecting the patient's upper body. The patient has since died.

Finding:

The Tribunal found Dr Wiggins not guilty.

The Tribunal found particular 1 was not established as Dr Wiggins was well aware the patient, at all material times, had a referral to a specialist to investigate the possibility of breast cancer.

The Tribunal found particular 2 was not established as had Dr Wiggins attempted to expedite the referral on the basis of the demonstrated musculoskeletal problems he would have had considerable difficulty in justifying his actions.

Particular 3 was not established as the Tribunal found Dr Wiggins was very responsive to the patient's concerns and suffering. He prescribed three drugs to assist the patient, ordered a blood test and when that pointed to a musculoskeletal problem he asked the patient to see him and he arranged for a referral to a rheumatologist.

The Tribunal considered particulars 4-6 together and found on the facts that they were not established.

The Tribunal recorded that it was satisfied Dr Wiggins' management of the patient was competent, appropriate, professional and diligent. The Tribunal found this was an extremely unusual and difficult case due to the way in which the breast cancer developed in the patient. The Tribunal also recorded it found the patient and her family to have been honest and understood the family's feelings of bewilderment, anger and sadness at the death of the patient in such complex and rapidly changing circumstances.