Unnecessary Deaths

Lee S. Goldsmith, M.D. LLB

Every year thousands of individuals die of cancer that could have and should have been diagnosed earlier. The three most common cancers associated with unnecessary deaths and litigation are Lung Cancer, Breast Cancer and Colon Cancer. 

LUNG CANCER: Every physician should know that smoking at any age increases the risk for the development of lung cancer. Every physician should know that individuals who have been pack-a-day smokers for years have an increased risk of developing lung cancer. Every physician should know that Cat Scan screening will lead to early diagnosis and treatment of lung cancer.

However, physicians do not refer patients for the screening. It costs the physician nothing, it costs the patient nothing. It requires a prescription. Yet over and over again patients are diagnosed with Stage 4 lung cancer, having been under the care of physicians who have not written that prescription. 

The physicians claim that there could be over-diagnosis and over-treatment, but they often do not even discuss the pros and cons with their patients. Litigation ensues, as do untimely deaths.

Failure to refer a patient for examination should result in more litigation against ill-informed internists and family practitioners.

Radiologists are also the subject of litigation as they fail to properly read and report the abnormalities on the films that are ordered. Often this is for patients who are getting a routine film without a history of smoking. 

BREAST CANCER:  Routine annual mammography and, when indicated, ultrasound, should be on the agenda for every woman. Women who do not undergo testing should be encouraged to do so, for a failure to diagnose the cancer early is their responsibility.  However, women who do have the routine testing often do not have their cancers diagnosed and this is often due to radiologists’ errors brought on by greed. Radiologists earn their income by reading films. The more films read, the more income earned. If the radiologist has to physically examine a patient with a “suspicious” reading on a film, that process cuts into reading time so patient contact is avoided. 

Women are not totally at the mercy of their radiologists. Doing self-examinations routinely and going for routine radiological studies will help prevent a late diagnosis. 

COLON CANCER: The recommendation is that everyone over the age of 50 should be screened. That age might have to be lowered, but that currently is the age. The process in messy, degrading and uncomfortable -- and should be done. Seeing a gastroenterologist and having the procedure performed allows for planning. If nothing is found, a repeat procedure is often delayed.  However, if a polyp is found and removed, that is one polyp that will not potentially turn malignant and one patient who may well not die an untimely death. 

We have handled one case where a cancerous polyp was missed on the routine examination, but that is a very rare occurrence. The cancer was diagnosed within months of a routine examination. When reviewing the prior colonoscopy films, it was found to have been present on two prior examinations and overlooked by the physician.