Abstract
Carolyn Buppert Failure to diagnose is the top reason physicians and nurse practitioners (NPs) are sued for malpractice. Lawsuits based on failure to diagnose often involve 1 of 3 cancers and 2 acute illnesses. The top 5 conditions that lead to malpractice claims for failure to diagnose—all generalists and specialists included— as reported by the Physicians Insurers Association of America are: 1. Breast cancer 2. Lung cancer 3. Myocardial infarction 4. Appendicitis 5. Colon or rectal cancer I consider the complaints associated with these conditions to be red flags, a warning that something demands attention. The red flag chief complaints are: 1. Breast lump, nipple discharge, breast rash, or enlarged lymph node in supraclavicular or axillary area 2. Chest pain or shoulder pain in an individual with a 20+ pack per year history of smoking 3. Chest pain in an adult 4. Lower abdominal pain On seeing one of these red flag chief complaints, a clinician should activate a system for diagnosis, rule-out, and follow-up. An NP who recognizes a risky situation can avoid delays that lead to patient injury and practitioner heartache. Here are 2 cases where NPs have not attended to the red flags.
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