Report on performance
Scenario 4
This 53-year-old male patient had not been seen by the practitioner for nine months. The patient presented 'as it was time to get his medications' and had a concern about cancer. No history was taken. The service provided was an MBS item 36 level C consultation.
Transcript of part of the discussion with the practitioner reads:
Chair Doctor, seeing a man that you are, you know, he makes a reasonable request to be checked out for cancer, what investigations would you normally consider, an alpha-feto protein and a CEA?
Practitioner Yes, it would depend on what sort of cancer, like, are we talking about ‑‑‑
Chair Well, this is - what, he is in his mid-50s or early 50s?
Practitioner Yes, he's - yes, he's 53, I - 53, or something. He is a moderate drinker. He drinks at the P---d Hotel and one of the two boys that he drinks with, they're all patients of mine, and somebody's come up with the fact that somebody had cancer of the something or other and he's probably said, 'I'm going to go up and see (the Doctor) next week and I'll mention it to him.' I can't remember much more than that.
Chair And in this situation would it be your normal practice to order an alpha-feto protein?
Practitioner Not normal, but something has drawn my attention to it and it's come up positive.
Chair So what were you looking for when you ordered the alpha-feto protein?
Practitioner The fact that there had been some sort of chronic liver something or other at some stage.
Chair What does an elevated - a significantly elevated alpha-protein suggest?
Practitioner Well, to me it would suggest probably do it again at some stage.
Chair Yes, and if you did it again and it was more elevated what would that suggest to you?
Practitioner I would do an ultrasound and find out what the liver looked like.
Chair And what would you be looking for in the liver with an elevated alpha-protein?
Practitioner Hepatoma.
Chair What would be - would it be much more common to have a bowel cancer than a hepatoma in a man who was worried about cancer?
Practitioner Yes.