In early March, six weeks after an unremarkable physical exam by a prior physician, a 62-year-old male truck driver saw his new primary care physician (PCP) for complaints of rectal bleeding. The patient, who had no record of any colorectcal cancer screening, reported no prior history of occult blood, and no family history of colorectal cancer. After a rectal exam showed blood, the PCP diagnosed it as “most likely hemorrhoidal.” He prescribed Citrucel and suppositories for hemorrhoid relief and documented that the patient would need imaging of some kind in the near future. The PCP instructed the patient to follow up in two weeks, and advised that a colonoscopy should be scheduled. No follow up appointment or imaging took place.
In May, the patient called the office for complaint of bloating and abdominal pain. The nurse he spoke to recommended that he alter his diet; no appointment with the PCP was requested or offered. In July, the patient again called the office with a complaint of abdominal discomfort, but did not make an appointment with his PCP. The PCP was unaware of the phone call.
In late November, the patient presented to the Emergency Department (ED) with anorexia, abdominal pain, and nausea (his stool was negative for blood). A physician assistant diagnosed a partial intestinal obstruction and discharged the patient with Pepcid for GERD. Three days later, the patient returned to the ED in severe, persistent abdominal pain and was rushed to surgery for a presumed bowel obstruction. The patient died two days after the surgery, which revealed advance colorectal cancer.