Family Medicine Experts Opine on Delayed Diagnosis of Colon Cancer

This case involves an elderly female patient who presented to her primary care physician with complaints of occasional rectal bleeding. According to the physician, the patient declined a digital rectal exam, despite the fact that one was allegedly offered. The plaintiff claimed that the benefits of the test were never discussed, and a colonoscopy was not offered as a next step in her treatment. The patient continued to complain of similar symptoms in subsequent visits, and had stated that the symptoms were becoming progressively worse. Eventually, the patient underwent a colonoscopy that discovered a cancerous growth. It was claimed that the cancer would of been diagnosed earlier had proper treatment been rendered.

Question(s) For Expert Witness

1. What is the protocol for educating patients with rectal bleeding who decline DREs?

2. What is the standard follow-up for a patient with this presentation?

Expert Witness Response E-108396

Unless contraindicated, a digital rectal exam is always recommended as part of the examination for rectal bleeding. With any intervention or examination, patients should be informed of the purpose of the examination and the risks of not doing an examination if declined. In the case of a declined DRE for rectal bleeding, patients should be informed of the potential for missed cancer, difficulties adequately diagnosing a persons symptoms and delayed diagnosis. Typically a person with rectal bleeding of unknown etiology on history/examination should undergo timely investigations with colonoscopy.