Primary care clinicians who see patients ages 40–70 are at the front line of cancer detection and, thus, at risk of an allegation that they failed to make a timely cancer diagnosis. Practices that may help primary care providers reduce their risk of being sued include routinely updating family histories,recognizing cancer risks for younger patients with certain histories and symptoms,1 and coordinating care with other providers who share a patient’s diagnostic process.
The four most commonly diagnosed cancers for U.S. adults2 are:
- Breast (269,000 annual diagnoses)
- Lung (234,000)
- Prostate (165,000)
- Colon and Rectal (140,000)
Given the impact of such diagnoses on quality of life and life expectancy, it is no surprise that a failure to diagnose one of those cancers is among the most common allegations in medical professional liability (malpractice) claims and lawsuits. Analysis of more than 95,000 cases reported to CRICO’s national Comparative Benchmarking System (CBS) found 1,684 cases filed from 2007–2016 with an allegation of a missed diagnosis of one of those four cancer types. Over the same 10-year period, 1,892 cases involving those cancers were closed, with an average payment of $439,000.
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CANCER | CASES FILED | CASES CLOSED | |||||
# CASES | AVG | # CASES | CLOSED | AVG PAYMENT4 | |||
Breast | 598 | $263K | 658 | 38% | $396K | ||
Lung | 524 | $282K | 569 | 38% | $451K | ||
Colorectal | 384 | $266K | 452 | 37% | $491K | ||
Prostate | 178 | $273K | 213 | 42% | $431K | ||
Total | 1,684 | $271K | 1,892 | 38% | $439K | ||
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Considering the national volume of cancer diagnoses, allegations of malpractice are extremely rare, but they are worth examining. Incidents that evolve into medical malpractice cases do, generally, represent a subset of similar adverse events. Clinicians who see patients in the key demographic segments most susceptible to these common cancers are at risk for a missed or delayed diagnosis, even if they have never been named in a malpractice case.
While routine screening can be a valuable tool for cancer detection, it is not infallible. Many cancers are undetected in their early stages despite diligent compliance with recommended screening regimens. The CBS case details indicate that allegations of malpractice related to missed cancers are often triggered by breakdowns in the broader diagnostic process. Systemic failures and cognitive errors throughout the assessment, testing, and follow-up phases are relatively common.
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STEP | CANCER CASES5,6 |
1. Patient notes problem and seeks care | 1% |
2. History/Physical | 9% |
3. Patient assessment/evaluation of symptoms | 31% |
4. Diagnostic processing | 23% |
5. Order of diagnostic/lab test | 42% |
6. Performance of tests | 5% |
7. Interpretation of tests | 34% |
8. Receipt/transmittal of test results (to MD) | 6% |
9. Physician follow up with patient | 30% |
10. Referral management | 23% |
11. Provider to provider communication | 19% |
12. Patient compliance with follow-up plan | 20% |
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Clinicians—especially primary care providers—face an increasingly complex and imperfect set of processes for cancer screening and detection. Not every missed diagnosis is the result of clinician error but, too often, these cases reveal missed opportunities. By focusing on opportunities to employ decision support and effective communication techniques, clinicians who see patients for breast, lung, colorectal, or prostate health issues have a better change of avoiding allegations that they were responsible for a missed or delayed cancer diagnosis.
Notes
- Of the 1,684 patients in this analysis, 35 percent were under age 50 (including 54% of patients with breast cancers).
- American Cancer Society: Cancer Facts and Figures 2018. Atlanta, Ga: American Cancer Society, 2018.
- Includes reserves for open cases, and expenses and payments for closed cases.
- Includes defense expenses.
- Cases alleging a missed diagnosis of lung, breast, colorectal, or prostate cancer.
- A single case may have breakdowns in multiple steps.
Additional Material
July 2018 | by Jock Hoffman
