Delay in diagnosing colon cancer

Presentation

‍A 44-year-old man came to his family physician with a three-day history of rectal bleeding.

Physician action

‍Anoscopy revealed a torn internal hemorrhoid and a double contrast barium enema showed diverticulosis. The patient returned to the family physician eight months later and reported continued rectal bleeding. At this visit, the patient claimed that the physician told him that the rectal bleeding was due to his diverticulosis and was not life threatening. For this reason (according to the patient), the patient never reported continued rectal bleeding to the physician, despite numerous office visits and op­portunities to do so.

Four years later, the patient came to the physician’s office with rectal bleeding and severe abdominal complaints. The family physician referred the patient to a gastro­enterologist.

Colonoscopy and later surgery revealed Stage IV colon cancer with metastasis to the liver. The patient underwent colon resection and chemotherapy but his prognosis was very poor.

Allegations

‍A suit was filed against the family physician alleging failure to fully evaluate symp­toms suggestive of colon cancer and delay in diagnosing colon cancer.
 

Legal implications

‍In reviewing this case, defense consultants stated that a double contrast barium enema was inadequate to investigate the patient’s rectal bleeding when he first mentioned it to the family physician. The standard of care required that either a colo­noscopy or sigmoidoscopy be performed.

The physician was also unable to testify that he had inquired about continued rectal bleeding when he saw the patient eight months later. The consultants felt the standard of care required the physician to inquire about the previous rectal bleeding instead of relying on the patient to report a continued problem.

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Disposition

‍This case was settled on behalf of the family physician.

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‍More on diagnostic errors.

Risk management for adult primary care physicians.