Doctors Fail to Inform Patient of Liver Cancer

Case Overview

This case takes place in New Jersey and involves a female patient who presented to the ER in with abdominal pain. The ER ordered a CT, gave the patient various narcotic painkillers, and discharged him the next morning. The scan revealed a mass at the top of her liver. Her primary doctor saw the radiologist’s report and suggested a second CT be performed at the time. This was not done, nor was the patient notified of the mass or the risks involved. Some months later, she presented to his primary physician with pain in her side, and a CT scan was performed which revealed the mass had grown significantly since the last scan had been performed. The patient underwent surgery to remove the mass, and pathology identified the mass as cancerous. It is alleged that the patient’s chances of survival were severely diminished by the delayed treatment she received.

Questions to the Internal Medicine expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

As a primary care physician, I routinely encounter and treat patients similar to the patient described in the case. In terms of having had patients with liver tumors, I have had experience with diagnostic imaging to be ordered, treatment options based on those results, and post-operative long term management based on the tissue type found at surgery.

What would be the proper follow-up protocol, given the patient's presentation and the subsequent findings?

Given the aforementioned description, standard of care practice is to inform the patient of the abnormal mass and refer for further diagnostic imaging (including MRI) with consultation with the working diagnosis of liver cancer to be ruled out. Having an MRI with contrast performed would have led to the possible treatment with radiofrequency ablation of the tumor and potentially improved survival for the patient. On the other hand, giving the patient full disclosure allows the patient to participate in a limited period of close observation (3 to 6 months) where repeat scans are ordered and measurements showing growth of tumor would further convince the patient the need for earlier surgical intervention. Nevertheless, follow up with the patient regarding imaging is vital in the battle against what could be fatal cancer.

About the expert

This highly qualified and board certified Internal Medicine physician has over 25 years experience working in private practice. He is a member of the American Medical Association, the American College of Physicians and the American Society of Internal medicine. He has won multiple awards throughout his career including America's Top Doctor for three consecutive years. He is currently a physician at his own private practice as well as an attending internal medicine physician at several area hospitals.

E-001692

Specialties:

Internal Medicine