Author Credentials

Andrea M. Lauffer MD


electronic health record, coronary artery disease, communication, search for satisfaction, radiology, primary care, Swiss cheese effect


Cardiology | Internal Medicine | Radiology



Given the challenges in modern healthcare, physicians find themselves devoting a great deal of mental and emotional energy into executing the appropriate care for patients as well as performing their daily clerical duties. Many clinicians have resorted to innovative ways to minimize their tasks which often leads to narrowing the focus of a patient’s overall care and the birth of medical errors described in the Swiss cheese effect model.

Case Description:

A 66 year old male established care with a new primary care physician. Previous radiologic data revealed a pulmonary nodule that did not have appropriate follow up imaging. Repeat imaging showed a stable nodule in the final impression of the report. In the details of the report, coronary artery disease was noted, but it was not mentioned in the conclusion of the report. Patient was referred to cardiology for risk stratification and assessment, and he was found to have multi-vessel coronary artery disease requiring immediate coronary artery bypass grafting.


There is a demand for physicians to be efficient and productive in the face of an ever growing difficult healthcare culture. This creates a medium in which approach to patient care could be dangerously narrowed. This case illustrates that a final impression of a radiologic report should not be the only item read. A physician’s standard approach should be to look at the report as a whole to appropriately treat diagnosed and previously undiagnosed pathologies in order to decrease patient morbidity and mortality.