A timely diagnosis can make an enormous difference in a patient’s treatment and prognosis. When cancer, a heart attack, stroke, infection or another serious medical condition goes undiagnosed, valuable time may be lost.

But does a missed or delayed diagnosis automatically constitute medical malpractice?

No.

Doctors are not expected to diagnose every condition immediately, and some diseases are particularly difficult to identify in their early stages. The legal question is generally whether the healthcare provider acted appropriately under the circumstances — and whether a failure to do so caused the patient harm.

For Pennsylvania patients and families, understanding this distinction can help determine when a failure to diagnose or delayed diagnosis may warrant further investigation.

What Is a Failure to Diagnose?

Failure to diagnose occurs when a healthcare provider does not identify a medical condition that reasonably should have been identified under the circumstances.

A delayed diagnosis is similar, except that the condition is eventually identified after a potentially harmful period of time has passed.

Examples may include a physician failing to recognize symptoms of cancer, an emergency department sending home a patient experiencing signs of a heart attack, or a provider failing to order additional testing despite symptoms suggesting a serious condition.

The issue is not simply whether the first diagnosis was wrong. Doctors frequently must evaluate symptoms that could indicate multiple conditions.

Instead, a medical negligence investigation asks whether the provider took reasonable and appropriate steps to evaluate the patient’s condition.

When Can a Diagnostic Error Become Negligence?

Suppose a patient repeatedly complains about worsening symptoms.

The physician may have several reasonable diagnoses to consider. Depending upon the circumstances, appropriate care might include obtaining a detailed medical history, conducting an examination, ordering laboratory work or imaging, referring the patient to a specialist, or instructing the patient to return if symptoms worsen.

A malpractice claim may arise when a provider fails to take steps that were reasonably required under the applicable professional standard.

Potential issues can include:

• Ignoring significant symptoms
• Failing to order appropriate diagnostic testing
• Misinterpreting laboratory results
• Misreading imaging studies
• Failing to follow up on abnormal test results
• Failing to refer a patient to an appropriate specialist
• Failing to consider a serious diagnosis
• Failing to communicate test results to the patient
• Failing to recommend additional testing when symptoms continue

Each situation must be evaluated individually.

Failure to Diagnose Cancer

Cancer cases provide a particularly important example of why timing can matter.

Some cancers become more difficult to treat as they progress. A patient whose cancer could have been identified months earlier may argue that the delay allowed the disease to advance before treatment began.

But proving malpractice requires more than showing that cancer was eventually diagnosed.

The case may require examining what symptoms were present earlier, whether testing should reasonably have been ordered, whether imaging or pathology was interpreted correctly, and whether an earlier diagnosis likely would have changed treatment or prognosis.

These questions frequently require review by medical experts familiar with the particular type of cancer and the healthcare specialties involved.

Missed Heart Attacks and Strokes

Emergency medicine often requires providers to make decisions quickly.

Chest pain, shortness of breath, weakness, dizziness, confusion and other symptoms may have many potential causes. Some are relatively minor. Others can indicate life-threatening conditions such as heart attack or stroke.

A medical negligence claim may arise when healthcare professionals fail to appropriately evaluate warning signs, order appropriate testing or respond to test results.

For example, the question may be whether a reasonable emergency medicine provider should have recognized the possibility of a serious cardiovascular event and taken additional steps.

Again, the fact that a diagnosis was missed does not by itself establish negligence. The complete circumstances surrounding the patient’s presentation and care must be considered.

Failure to Follow Up on Test Results

Not every delayed diagnosis results from failing to order a test.

Sometimes the appropriate test is performed — and the breakdown happens afterward.

A radiology report may identify a suspicious mass. Laboratory testing may reveal a significant abnormality. A pathology report may recommend additional evaluation.

If important results are overlooked, never communicated to the patient or not appropriately followed up, a serious condition may progress untreated.

Determining responsibility can become complicated because multiple healthcare providers or systems may have been involved.

Our investigation may therefore examine not only the treating physician’s records but also hospital records, laboratory reports, imaging studies and communications among providers.

Causation Matters

One of the most important issues in a delayed-diagnosis case is determining what difference the delay actually made.

Consider two hypothetical patients whose cancer diagnoses were delayed by six months.

For one patient, medical evidence may indicate that the cancer had already reached an advanced stage before the first missed opportunity for diagnosis. For another, the evidence may suggest that the disease progressed substantially during the period of delay.

Those facts can significantly affect a malpractice claim.

The legal and medical analysis therefore focuses not only on whether the diagnosis should have occurred sooner, but also on whether the delay caused additional harm.

Why Medical Experts Are Important

Failure-to-diagnose cases can involve complicated questions of medicine.

Was the patient’s symptom significant enough to require testing? Would another physician reasonably have reached a different diagnosis? What would an earlier test have shown? Would treatment have been different? Would the patient’s outcome likely have improved?

These are questions that often require careful medical review.

Pennsylvania also sets standards governing who may offer an opinion about a physician’s care. In general, that opinion must come from a doctor who holds an unrestricted license, is engaged in active practice or teaching, and works in the same or a substantially similar subspecialty as the provider whose care is at issue.

Meeting that standard is one reason careful medical review is an important part of evaluating a potential malpractice case.

What Should You Do If You Suspect a Diagnosis Was Unreasonably Delayed?

If you believe a serious condition should have been diagnosed earlier, preserve as much information as possible.

Keep copies of medical records, test results, patient portal messages and correspondence. Write down the sequence of events while the details are still fresh, including when symptoms began, which providers you saw and what you were told.

Most importantly, consider speaking with an attorney experienced in medical negligence matters.

Patients are rarely in a position to determine on their own whether a diagnostic error violated the professional standard of care. Obtaining and reviewing the complete medical record can provide a much clearer picture.

Pennsylvania Medical Negligence Attorneys

A delayed diagnosis can leave patients and families wondering whether an entirely different outcome might have been possible with earlier treatment.

Those questions deserve careful investigation.

John A. Caputo and Elizabeth L. Jenkins of John A. Caputo & Associates, P.C. represent patients and families in Pennsylvania medical negligence cases, including claims involving failure to diagnose and delayed diagnosis.

If you believe a physician, hospital or other healthcare provider failed to timely diagnose a serious medical condition, call 412-391-4990 for a free consultation. When you call, you speak directly with an attorney. We handle these cases on a contingency fee basis — you pay nothing unless we recover compensation for you.