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A year and a half after ER doesn't inform patient of x-ray finding, man dies of cancer

Increase your patient safety by always getting a copy of test results

A recent case shows why I think it’s important for patients to get a physical copy of any lab work, pathology study, or radiology tests ordered as a part of their healthcare. If it’s important enough to order, it’s important enough for the patient to know the results.

A 48 year old man went to a hospital emergency room (ER) after a two-day bout of productive coughing, congestion, and shortness of breath. He was a smoker. The ER nurse and doctor found his vital signs to be normal, but heard wheezing with the stethoscope.

The ER doctor ordered chest x-ray, which he interpreted as normal. They treated the wheezing with an albuterol hand-held nebulizer (HHN), and the patient seem to respond well to it. The doctor discharged him from the emergency room with a diagnosis of bronchitis, along with prescriptions for antibiotics and an inhaler.

After the patient had already been discharged home, the radiologist read the chest x-ray and wrote a report identifying a small pulmonary nodule. The radiologist recommended a repeat chest x-ray or CT scan in six months. The radiologist’s report apparently went unnoticed by any physician or nurse in the emergency room, so it was filed away and no one notified the patient.

Fast-forward 20 months. The patient is dead from metastatic lung cancer.

As a former hospital administrator, I call this a system error. That hospital had poor policies and procedures to make sure that reports from radiologists, pathologists, and laboratory personnel didn’t fall through the cracks. In the emergency room setting, this poses a particular risk to patients because final interpretations, like in this case, are often not complete until after the patient has already gone home.

Even when a patient is hospitalized, though, there are ample opportunities when things can go amiss. The standard care requires radiologists, pathologists, and lab tech to communicate critical findings that pose a significant risk to the patient unless they’re treated. This requires more than just writing a report and saving it into the electronic medical record. With critical findings, it requires direct communication over the phone or in person with the ordering provider.

The case I just shared with you illustrates another risk called incidental findings. When the radiologist reviewed this patient’s chest x-ray, she didn’t find a critical finding. The ER doctor ordered a chest x-ray to look for signs of an infection or pneumonia. The fact that the radiologist noticed the small pulmonary nodule is, therefore, called an incidental finding.

Sometimes, incidental findings could be better described as a blessing or good luck. It certainly benefits the patient to be informed about. If this 48 year old man had known about the incidental finding of a pulmonary nodule, he would’ve likely received follow-up care that would have identified his cancer in time to be treated. Instead, he died.

You can reduce your risk at every encounter with the physician or hospital by asking for a printed copy of all lab work, pathology tests, or radiology scans that are ordered. While you may not understand everything in them, you’ll be able to see any abnormalities that are referenced and ask your physician about it. The simple step could prevent something important from falling through the cracks in your healthcare.

If you’ve been seriously injured by poor communication from a physician or hospital, then a top-rated Houston, Texas medical malpractice lawyer can help you evaluate your potential case.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

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