Patricia Buckley was a retired teacher who lived most of her life in the midwest, but
had recently moved to Dayton, Ohio. She shared a small 1-bedroom apartment with her trusted
companion of many years - a parrot named Mr. Gatsby. Most nights she would watch movies,
but occasionally she enjoyed hosting small dinner parties. One morning, as Patricia was
cleaning her house, she suddenly felt tired and dizzy, and as the day progressed, she
felt more achy and developed a slight cough. “I hope I’m not getting sick right before
my trip to Europe,” she thought aloud, as she picked up the phone to make an appointment
with her primary care physician.
The next day, Patricia arrived for her appointment with her primary physician, Dr. Larson. The
conversation was relaxed. Patricia said she was mostly worried about the fatigue. She
explained, “I’m going to visit my daughter and my lovely grandson in Europe for the summer,
and I'm pretty sure I won't be able to keep up with him or help around the house if I’m
exhausted like this.” Dr. Larson explained that she thought it was most likely a viral
infection, but that she needed to get some blood tests and a chest X-ray just in case
Patricia had developed a walking pneumonia or something called parrot fever - both of
which could be treated with antibiotics. Patricia felt reassured and headed out to get the lab
work and chest X-ray done.
A few hours later, an overnight radiology fellow, Dr. Samir Patel, was reading the chest
X-ray of patient 7322881. He didn’t know Patricia - he just knew her medical record
number. The reason for the chest X-ray? Two words “rule-out pneumonia”. He squinted
at the image and sipped his Chamomile tea. No signs of pneumonia, but he noticed a small
oval shape on her left upper lobe. “Could this be a tumor? Or tuberculosis?”, he wondered
as dictated the report. “Findings: No evidence of pneumonia. 1-centimeter oval lesion in
the left upper lobe. No hilar adenopathy...“ he finished up. He clicked over to review
the next case. A few hours later he called it a night.
The next morning Dr. Patel reviewed the radiographs from the previous night with his attending.
The attending agreed - there wasn’t any evidence of pneumonia, but that oval shape
was unusual and definitely needed following up on. Dr. Patel wrote down the patient’s
phone number on a pad of paper.
Dr. Patel batched all of his follow up calls and did them each Friday. That Friday, when
he called Patricia nobody answered and he left a voicemail. A week later he called again,
and left another voicemail. Two weeks later the voicemail inbox was full and wasn’t
accepting any more messages. Dr. Patel struck the number off his list - by that point, he
could barely remember what the call was even about.
What Dr. Patel didn’t know was that Patricia was in Switzerland and wasn’t getting her
voicemails. Near the end of the summer, Patricia’s health rapidly declined so she flew back to
the US to stay with extended family. A few weeks later, Patricia passed away due to metastatic
lung cancer.
One afternoon, Dr. Patel received a letter stating that his hospital was being sued and
that he was named in the lawsuit because he had done the initial dictation on the chest
X-ray.
Now - to rewind this back - let’s imagine that Dr. Patel or someone on his team had
gotten in contact with Patricia’s primary physician, Dr. Larson. Dr. Larson had a more
established relationship with Patricia and may been able to contact her while she was
in Europe. It’s possible that Patricia could have had further studies done to work up this
lung nodule - perhaps a CT or MRI. An earlier diagnosis might have given her a better shot
at chemotherapy, and perhaps she wouldn’t have died. The moral? Share incidental findings
and other clinical information with the primary care physician as well as the patient.