Underdiagnosed and undertreated colorectal cancer tops liability list.

UNLABELLED: A morbidly obese 42-year-old man complained to his primary care physician of pain in the right lower abdomen and groin that was aggravated by standing and walking. The general exam was unremarkable except for some tenderness on deep palpation of the right groin area. An abdominal examination was unsatisfactory because of obesity. The physician suggested the possibility of a right inguinal hernia, but was reluctant to commit to this diagnosis because of the poor abdominal exam. He charted "Impression: possible right inguinal hernia. TREATMENT: 1) lose weight, 2) Donnatal AC & HS." Eight weeks after the initial visit, the patient returned with the same complaints. Both the exam and vitals were unchanged from the previous visit. Six months later the patient's weight and abdominal exam remained the same, but his pain was worse. He reported that he had bright red blood in his stool twice. A rectal exam was essentially normal, though a fecal test was guaiacpositive. The patient was immediately referred to a local surgeon for consultation. After routine colon prep, the surgeon performed a flexible sigmoidoscopy. He found a lesion. The pathology report noted an adenocarcinoma of the colon. A left colectomy revealed some serosal involvement and several positive mesenteric nodes. Three months after the surgery, the patient sued the original family physician, alleging delay of diagnosis. The plaintiff supported the claim with a statement from the attending surgeon that said the family physician negligently tested and followed up with the patient.