Table 1.

Summaries of Case Abstracts

Case	Summary
1. Alleged failure to diagnose coronary artery disease	The patient was a 47-year-old man who complained of chest pain and requested medical clearance for an exercise program. The pain occurred at random times, was unrelated to exertion, and lasted one minute or less. It involved the left side of the chest and the anterior axillary line and did not radiate elsewhere. The pain was precipitated when his arm was held out and relieved when the arm was returned to his side. The physician's record indicated that if the patient subsequently recognized an exertional component to the pain or the pain persisted he should schedule an exercise tolerance test. The patient died three months later from a cardiac arrhythmia that the autopsy concluded was due to coronary artery occlusion.
2. Alleged failure to make a timely diagnosis of appendicitis	The patient was a 29-year-old woman who presented to the emergency room after three days of abdominal cramping. On physical examination she had active bowel sounds, a thick white cervical discharge, cervical motion tenderness, and tenderness in the right adnexa. There was no rebound tenderness, distension, or rigidity. Vomiting was not a prominent symptom. The ultrasound report was normal except for a large collection of fluid and debris in the posterior cul-de-sac. The patient did not respond to antibiotics given for presumptive pelvic inflammatory disease, and on the fifth day of hospitalization she had a laparoscopy that revealed a ruptured appendix.
3. Alleged failure to make a timely diagnosis of breast cancer	The patient had a normal mammogram in June. In September, she had a small axillary node and was told to have another mammogram, which for unexplained reasons, was never performed. Six months later she had a lump in her breast, a positive mammogram, and a biopsy that showed breast cancer. The patient died from breast cancer 21 months after the diagnosis.
4. Modification of case 1	The patient survived myocardial infarction.
5. Modification of case 2	The patient had a difficult six-month postoperative course with several surgeries to lyse adhesions and drain recurrent abscesses. These surgeries finally resulted in a bowel resection and a colostomy.
6. Modification of case 1	The patient complained during a first office visit of a new burning chest pain precipitated by exercise and that resolved with rest, and complained during a second visit that the pains occurred with less exertion than previously. To make the physician's behavior more understandable, the abstract reported that the patient presented the critical information during the second visit on his way out of the office after he had arrived 15 minutes late for his appointment and put the physician behind schedule. In addition, the physician had a vacation scheduled shortly after seeing the patient and could not reschedule the patient for another three weeks. The patient had a nonfatal myocardial infarction one week after the second exam.