製薬業界で 12 年以上キャリアを持つ Sharon 先生による医療コラムをお届けします。
特集：医療英語 > Case 3: Colon Cancer - 結腸癌 -
A 60-year-old male visited his primary care physician complaining of abdominal cramps and blood in his stool. Upon examination the patient was noted to be severely overweight and a smoker. He mentioned that his uncle had died of colon cancer at the age of 65. Physical examination, including rectal exam, were normal. His stools were guaiac-positive but other laboratory findings were unremarkable. The physician mentioned that a colonoscopy would be advisable and ordered the patient to return in one week if the cramps did not subside.
Three months later the patient returned to the doctor complaining of flu symptoms. The physician treated him with antibiotics. The abdominal cramps, blood in the stool and colonoscopy were not discussed.
Six months later the patient presented with lower abdominal pain. His stools were guaiac-positive again. The physician ordered a colonoscopy. The colonoscopy revealed a large ulcerated lesion five centimeters proximal to the rectum. Biopsies revealed an adenocarcinoma. The patient underwent a colectomy and chemotherapy but died one year later.
The patient's family filed a claim against the physician for failure to diagnose the colon cancer during the patient's initial visit, which would have greatly improved his prognosis.
Since the initial stool samples were guaiac-positive and the patient mentioned a family history of colon cancer, the doctor should have requested a colonoscopy immediately, not just mention that it would be advisable. Furthermore, the doctor should have followed up or asked about the colonoscopy when the patient visited his office two months later.
In addition, the patient was not informed of the potential consequences of a guaiac-positive stool. If the physician had provided additional information the patient probably would have been more inclined to have the colonoscopy. But since the physician did not appear too concerned and the abdominal cramps disappeared within a few days, the patient did not have the colonoscopy.
- Please summarize this case. What is the main point of the article?
- Was the patient's initial work-up complete?
- Was his second work-up complete?
- Did the physician provide the patient with sufficient information regarding his guaiac-positive stools? Why or why not?
- Why is patient education important?
- Was the physician negligent? Why or why not?