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CLINICAL CASE Physician's Accountability for System Failure

Mrs. Taylor went to see her internist because she had been suffering from shortness of breath during her usual exercise routine for several months. Otherwise, she was in excellent health. When her symptoms did not improve after several weeks, her internist ordered a chest X-ray that revealed an opacity in the right lower lobe of her lung. A follow-up CT scan showed an effusion, so her internist referred her to Dr. Jones, a pulmonologist, for a thoracentesis and further workup.