Physician's Failure To Communicate Lab Results Leads To Delayed Cancer Treatment

Case Overview

The test was ordered but the results were never communicated to the patient. Because he never heard from the physician’s office, the patient assumed that the test had come back normal. The patient came back a year later for another screening and the results came back well above 4.0 ng/mL. It was later discovered that the patient’s original lab results were high enough to warrant a biopsy 12 months earlier. The physician’s office alleged that the results were never sent to their office. The patient’s health rapidly deteriorated and he was diagnosed with prostate cancer. The patient died within 19 months of receiving his diagnosis.

Questions to the Internal Medicine expert and their responses

What is the standard of care regarding documentation of lab orders ordered on a patient?

Any lab tests ordered that do not arrive in the office should be traced. Office procedures should be in place to ensure both occur.

What is a doctor's duty to follow up on labs orders when they are not received?

It is not an adequate defense to say that the lab test was not received in the office.

What is the standard of care to report abnormal PSA results to patients?

Abnormal test results of any kind should be communicated to a patient in a timely fashion.

What is the standard of care to advise a patient with an abnormal PSA on treatment options?

Most primary care organizations now recommend against routine PSA testing. If a test is performed, it should only be after a discussion about potential harms and very few, if any, benefits.

About the expert

This expert is highly qualified and board certified in Family and Preventive Medicine. He obtained a double degree in Biology and Chemistry from Arizona State University. He pursued a Doctorate in Medicine at the University of Arizona College of Medicine, and then completed a residency in Family Practice at the University of California, Davis. He is heavily involved in research and academia. He has published over 80 peer reviewed articles, over 6 books and over 110 book chapters. He is currently serving as a Medical Director of the Department of Family Medicine at a medical center. In addition, he is also a Professor of Family, Community and Preventive Medicine at a respected medical school.