When is the Physician Liable?

Family practitioners, obstetrician-gynecologists, and internists are gatekeeper physicians with the first professional opportunity to detect breast cancer. When they fail, the results can be fatal.
The women most affected by delay in diagnosis tend to be young (under 40). They typically have relatively high socioeconomic status and are covered by private health insurance.
The typical scenario is as follows. The woman presents with a self-discovered mass that is painless. The doctor performs a physical exam and feels a mass but believes it to be benign because of the patient’s age. The doctor orders a mammogram, and the results are negative for abnormalities or malignancy, despite the palpable mass. The patient is diagnosed with fibrocystic disease, which is hormonally induced, and told she does not have cancer. Of course, she is tremendously relieved. The doctor does not recommend a biopsy or refer the patient for further consultation.
A delay of an average of 13 to 15 months precedes the ultimate diagnosis of breast cancer. When the diagnosis is eventually made, the cancer will be at a more advanced stage.1
In three studies of women with breast cancer diagnostic errors, over 80 percent of the women discovered their breast mass and then went to see a doctor.2

The failure of the physician to be concerned about the mass accounts for most of these errors. Many errors are attributed to the physician’s disbelief that cancer occurs in young women.3

Many women are well educated about this horrible disease. They are aware of breast self-examination and diagnostic tools like mammograms. They recognize that early diagnosis and treatment mean a greater likelihood of survival. Yet, when they discover their own breast mass, and their physician tells them not to worry because it is fibrocystic disease, which later turns out to be cancer, they become justifiably angry.

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