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Melanoma of the Foot – A Case Study in Delayed Diagnosis

Melanoma of the Foot – A Case Study in Delayed Diagnosis

(*Note: This case study is an example based upon cases that we have observed and in which we have been involved.  No two cases are exactly alike, so if you have questions, contact us to discuss your specific case).

In the field of podiatry, as with most medicine, there often comes a critical moment where the podiatrist must make a decision.  And for better or worse, that decision can impact the health and safety of the patient.

That decision is a referral or diagnostic test.  It's an acknowledgment by the podiatrist that he or she does not know what the problem is, and that someone else should take a look.

Such is the case with a delayed diagnosis of foot cancer.

Jane was 58 years old.  She was an avid runner, and lived what would universally be considered a healthy life.  She ate well, did not smoke, and drank alcohol in moderation.  She was not overweight.

Jane had a history of suspicious basal cells in her foot, but in the past,  they had turned out okay.

Jane and her husband moved to a small town in New Hampshire.  Shortly after moving she developed an open wound on the bottom of her foot. 

Jane did some research, and found the only podiatrist in the area.  She made an appointment, and went on to treat with the podiatrist for the next seven months.

During this time Jane's wound did not get better – in fact it got worse.  Unfortunately, the podiatrist made incorrect assumptions about the wound, and never considered that given Jane's history, the wound could be cancerous.

Jane's podiatrist never performed a biopsy of the wound.  She never referred Jane to a specialist. Jane, like most patients, simply assumed that the podiatrist knew what he was doing, and that the wound would, eventually, heal.

She was wrong.

After treating with her podiatrist for seven months, and seeing no improvement in the wound, Jane went for a second opinion at the local teaching hospital.

Immediately upon seeing the wound, the physician at the hospital ordered a biopsy.  Jane's fears were confirmed when she was diagnosed with Stage IV melanoma.

What the doctor should have done

Generally speaking, when a patient has a wound like Janes that does not heal in four weeks, further diagnostic testing should be performed to determine what is really going on.  In Jane's case, the podiatrist simply did nothing, assuming that the wound was something other than a melanoma.  As most people know, early detection in cancer cases is critical to slowing the spread.

Even if Jane's podiatrist did not order a further diagnostic test, he should have realized after several weeks that something else was going on, and if it was outside of his expertise, he should have referred Jane to a colleague or specialist for a second opinion.

Unfortunately, in our experience three factors often come into play in cases where a podiatrist fails to refer a patient out. 

The first is that the podiatrist has tunnel vision, and believes he has determined the problem and fails to consider other possibilities. 

The second is ego – the podiatrist believes that he is certainly well suited to make a diagnosis and treat a patient, and would feel embarrassed to acknowledge to another podiatrist that he needs a second set of eyes. 

And finally, the third is economics.  The fact of the matter is that podiatrists are in business, and the referral of a patient away from the office equates to a loss of revenue.  We are not suggesting that there is an intentional failure to refer because of money, however when you combine that subliminal concern with ego and/or tunnel vision, you create a potentially dangerous situation.

Jane's case is a frightening one, because it was a preventable one.  In her case we had the case reviewed by a top podiatrist, who confirmed that Jane's podiatrist made egregious errors that were outside of ordinary standards of care. 

From there a lawsuit would be filed, seeking damages for Jane's prognosis.  Not only does a lawsuit attempt to make Jane whole, however, it also sheds light on a real problem in the healthcare system and, hopefully, sets an example for this and other podiatrists.  Our goal is that the next time this podiatrist (or anyone else who hears about the case) treats a concerning patient, he makes the right call and orders a test or makes a referral.  It could, literally, save a life.

If you have questions about a delayed foot cancer diagnosis, contact us today.

*This article is not intended to convey legal advice, and does not form the basis for an attorney client relationship.

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