Where I grew up, basketball is a big deal. The high school basketball coach would go to elementary school games as a sort of scout for future team members. During the summers, he hosted basketball camps at the local YMCA to teach basic skills.
Needless to say, this coach was pretty intense. One of the things that he pounded into us over and over was the need to follow through when making a shot. Following through made all the difference.
Just like in basketball, following through has an important role in medical care. Take diagnostic radiology scans, like MRI and CT scans, for instance.
A doctor who is seeing the patient in an emergency room, hospital, or office identifies some areas of concern that leads to an order for a CT or MRI scan. These are called the indications for a scan. An order is than generated, which contains the indications for the study.
The order is transmitted to a radiology department, where a technician performs the scan. Once the scan is complete, the images and clinical indication for the study are transmitted to a radiologist for interpretation. The indication helps the radiologist to know what to focus on when reviewing the images.
Sometimes, the radiologist will identify abnormalities that are unrelated to the indication for the study. These are called incidental findings. For example, we represented a central Texas woman in a medical malpractice case involving a reported surgical management of a celiac aneurysm. The aneurysm itself had been discovered as an incidental finding in a CT scan that had been ordered to evaluate her back pain.
Whether the radiologist reports findings related to the clinical indication and/or incidental findings, the radiologist may recommend additional workup or studies. This is when the follow through comes into play. If a CT scan had been ordered, for example, the radiologist may recommend an MRI for a more sensitive scan to investigate an area of concern. Or, in the case of an incidental finding, it may be necessary to have a more focused study on that area alone.
When there’s a lack of follow through on radiology studies, the healthcare providers can miss the shot, leading to dire consequences for the patient.
That’s what happened to a senior citizen who went to a hospital emergency department because of worsening problem with shortness of breath. He was concerned because of his past medical history of a coronary artery bypass, heart attack, angioplasty, and multiple stents. He regularly took baby aspirin.
The emergency physician quickly ordered a consultation with a cardiologist, to evaluate his heart and cardiovascular conditions. The cardiologist performed an EKG, which showed no evidence of an acute heart attack.
The cardiologist also ordered a CT scan of the chest. The radiologist interpreted the CT scan as showing some noncalcified pulmonary nodules. In the radiology report, the radiologist recommended either follow through of a PET/CT scan or a repeat CT scan in 4–6 months to reevaluate the possibility of a malignant cancer.
Three days later, the patient was discharged, with recommendations to get a pet or CT scan in that time frame.
The cardiologist saw this man in the office three months after he was discharged from the hospital. He continued to have shortness of breath and had pain in his abdomen. The cardiologist didn’t reference the mentioned abnormal CT scan from the hospital and simply instructed the patient to return to see him in three months.
The patient was compliant and saw the cardiologist three months later and once again three months after that. During those repeated follow-up visits, the cardiologist didn’t mention the radiologist recommendation for another CT scan or PET/CT scan, and didn’t order further testing.
Around a year after his hospitalization, the man returned to see the cardiologist with the complaint of chest pain. The cardiologist finally ordered repeat CT scan. The radiologist compared the new scan with the one from a year prior and noted the presence of multiple masses in both lungs and a high suspicion for malignant cancer. A CT-guided biopsy followed, which confirmed a small cell neuroendocrine carcinoma, a type of cancer.
The patient pursued a medical malpractice lawsuit against the cardiologist, alleging that he failed to follow through with the radiologist’s documented recommendation for follow-up testing to evaluate the suspicious area that he saw on the CT scan.
There is no doubt that the cardiologist and his office staff dropped the ball. Despite repeated follow-up visits, neither the cardiologist nor the office staff apparently reviewed the patient’s prior records, which would have immediately identified the need for the cardiologist to order an additional CT scan or PET/CT scan. In other words, there was no follow through.
Without that follow-through, there was a delay in diagnosis and treatment of the man’s cancer.
This situation reminds me of the importance for patients to ask for copies of radiology reports, so they can read them themselves and ask questions about recommended follow-up. This provides a safety net to guard against inattentive doctors failing to follow through.
If you’ve been seriously injured because of poor medical or hospital care, then contact a skilled, top-rated Houston, Texas medical malpractice lawyer for help in evaluating your potential case.
