March is Colorectal Cancer Awareness Month. Colorectal cancer (“colon cancer”) is the second leading cause of cancer death in the U.S., behind only lung cancer.
When we talk of medical malpractice, we need to know about the “standard of care” under a certain set of facts. So, in terms of colorectal cancer prevention, what is the standard of care?
Normally, the standard of care is not something concrete or written down in the hospital because each patient and their unique situation comes with a standard of care. For example, if I (a relatively healthy male in his 40’s) went to the doctor for a mere cough, the standard of care would not necessarily be to order a chest X-ray. But if I had a sore throat, Tylenol-resistant fever, rash, and a headache, that would indicate a possible respiratory infection and an X-ray should be ordered.
Colon cancer is now so common and so readily recognized at an early stage with a simple test, that the standard of care for its prevention is less and less patient specific. Courts can be persuaded that the standard of care requires that a primary care physician must order colorectal screening when any patient reaches the age of 50 (or even age 45) unless there are reasons the patient could not safely undergo the testing.
Of course, patients at increased risk for colon cancer (those with a family history, for example) may have a different standard of care as far as screening. Doctors and patients may consider a variety of factors in deciding which test may be best for each person. For example, the tests require different frequencies of screening, location of screening (home or office), methods of screening (stool-based or direct visualization), pre-procedure bowel preparation, anesthesia or sedation during the test, and follow-up procedures for abnormal findings.
For a doctor to be “on the hook” to order a colon cancer screening for a patient age 50+, that doctor must have a duty to do so. Seeing a doctor once for a check-up at age 47 may not cut it. To have that “primary care physician-patient” relationship, there should be regular, ongoing wellness visits in addition to sick visits or referrals to specialists. The relationship at the relevant time between doctor and patient determines the duty owed.
Obviously, I hope no one must endure any sort of cancer, including colorectal. The best course is to establish regular care with a primary care physician, make sure you attend all appointments, and be aware of your health risks as you age.