Delayed Diagnosis and the “Differential Diagnosis” Rule

A delayed diagnosis often compromises care and can occur in almost every medical setting.

For example, an individual with symptoms of internal bleeding presents to an Emergency Room. The hurried ER physician assumes the patient is stable without tests to rule out a bleed. If the patient goes on to suffer serious complications by the delay in diagnosis, they may have a strong case of malpractice.

A “delay in diagnosis” can arise in other settings, such as Primary Care, if a physician does not order workup for possibly dangerous conditions that are suggested by symptoms.

One example of this case type, in which we obtained a verdict for Plaintiff, involved delayed diagnosis of a pulmonary embolism. A pulmonary embolism is a blood clot that moves to the lungs, typically arising from one that has been persisting in the leg for days or weeks (known as a deep vein thrombosis or “DVT”). Unfortunately, an undetected pulmonary embolism can become rapidly fatal –hence the importance of a timely diagnosis for DVT or pulmonary embolism.

In this particular case, the physician was found liable for not conducting blood tests that will usually diagnose a DVT: the jury finding that the physician failed to appreciate symptoms suggesting that a DVT had been developing in the days preceding a fatal outcome from pulmonary embolism.

Common to many “delayed diagnosis” cases is a failure of the physician to apply what is known as “Differential Diagnosis.” Physicians are taught, from medical school and on into specialized practice that they are supposed to make a list of what may reasonably be the cause of a set of symptoms.

Typically a set of symptoms, or test results, may have more than one cause. But if a reasonable explanation is that symptoms could be due to something serious, or medically urgent, the physician is supposed to “rule out” that possibility. This process of considering the potentially serious causes of symptoms, and “ruling them out” before assuming it’s something minor, is following the “Differential Diagnosis” method. If instead, a physician just assumes the cause is not serious and fails to rule out the serious possibilities, that physician may be liable for malpractice if harm results to the patient.

A significant category of “delayed diagnosis” cases arises in failing to timely diagnose cancer. In cancer, an early diagnosis is almost always better. Conversely, a delayed diagnosis of cancer may be responsible for advanced-stage cancer, and much more damaging treatment, and worse prognosis. See Cancer Cases

Physicians are taught and are supposed to use the “Differential Diagnosis” method to “rule out” medically urgent situations if they are reasonably suggested. A common example of how this rule is applied would be chest pain. If an adult goes to an Emergency Room with serious chest pain it may, or may not, be a heart attack. However, due to the potential urgency and seriousness of a heart attack, the ER is required to “rule out” a heart attack, even if the symptoms may turn out to be indigestion.

While the facts vary among many types of cases and can be complex. Nonetheless, we have found that many cases of delayed diagnosis are really a type of failure to follow a “Differential Diagnosis” rule.