A diagnosis of cancer does not always need to be directly communicated. However, special care must be used to ensure receipt of the diagnosis by the clinician in the best position to coordinate or provide treatment to the patient. The following case highlights the importance of creating a “paper trail” that proves pathology diagnoses were sent to the intended clinicians.
The defendant physicians failed to notify the patient of a positive biopsy resulting in delayed breast cancer diagnosis.
A radiologist reported a mammogram impression of Category 4C (suspicious of malignancy) to the patient’s OB/GYN. The OB/GYN ordered a biopsy. The biopsy was completed by a radiologist, who sent the sample to a pathologist. The pathologist diagnosed infiltrating moderately to poorly differentiated ductal carcinoma. It was the pathology lab’s practice to send pathology reports to the ordering physician and the patient’s primary care physician (which in this case was the OB/GYN). However, in this case, the report was not communicated to the OB/GYN, and the CC on the report only listed the radiologist. The radiologist received the report but assumed someone else would advise the patient of the results. The patient was never informed of the results and assumed they were negative. One year later, the patient learned of the cancer diagnosis. She sued the OB/GYN, radiologist, and pathologist.
Experts were in disagreement over whether the standard of care required the pathologist to send the report to both the ordering physician (radiologist) and the primary care physician (OB/GYN). In this case, the primary care physician was known; therefore, there was even less reason for the pathologist’s failure to notify her. The pathologist could provide no evidence of having communicated the cancer diagnosis to the OB/GYN other than testifying that doing so would be his standard practice. The OB/GYN vehemently denied receiving the pathology report. Each defendant blamed the other: the OB/GYN for not following up, the radiologist for not passing the information to the OB/GYN, and the pathologist for not communicating the diagnosis to the OB/GYN. If the pathologist had evidence of having communicated the diagnosis to the OB/GYN, he most likely would not have been involved in the lawsuit.
Pathologists
Evidence of the communication of a diagnosis can become a critical aspect of a pathologist’s defense in a malpractice lawsuit. Consider the following recommendations:
Ordering Physicians
Redundancy in a communication system makes it safer. Do not assume that a different member of the patient’s healthcare team will communicate an actionable diagnosis to the appropriate clinician. Err on the side of caution.
A clinician who requests a pathology consultation is generally held responsible for following up on the results and communicating them to the patient’s clinicians in the best position to use the information for treatment purposes. Prompt diagnosis and treatment often requires the coordinated effort of the patient’s entire healthcare team. Avoid being the weak link in the communication chain.