A family medicine expert witness opines on a case involving a fifty-five-year-old female with a past medical history of migraines and IBD. She presented to her primary care physician complaining of non-specific pain in the abdomen and back. On examination of the patient, the treating physician did not find anything significant. The physician ordered a CT scan of the abdomen and pelvis. The scan revealed a sub-centimeter hyper-dense lesion involving the left mid kidney that may have represented a hyper-dense cyst, or other etiology. The radiologist who reported these findings suggested to the treating physician that follow up with a repeat sonogram or CT scan in three months was warranted to monitor the mass. The treating physician did not order any further investigation of the mass. The physician did not order follow up of the patient. Sometime later, the patient returned with severe lower back pain, abdominal pain, and lower right-sided pain. Physical examination of the patient’s abdomen revealed a palpable mass in the right flank. Upon repeat CT scan of the abdomen and pelvis, it was the revealed that the mass, which was less than a centimeter on initial medical imaging, had grown to four centimeters.