| Course | PA 503 Essential Foundations in Clinical Medicine |
|---|---|
| Week | 8 |
| Paper type | Diagnostic error analysis |
| Length | About 1,100 words, 5 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | Master of Physician Assistant Studies (MPAS) |
| Updated | October 2026 |
Free sample paper for PA 503 Week 8
Diagnostic Error Analysis: Two Visits for Bronchitis, a Normal Chest X-Ray and a Lung Cancer Found Five Months Later, Traced to One Decision Point
Student Name
Chamberlain University
PA 503: Essential Foundations in Clinical Medicine
Instructor Name
Month Day, Year
Diagnostic Error Analysis: Two Visits for Bronchitis, a Normal Chest X-Ray and a Lung Cancer Found Five Months Later, Traced to One Decision Point
The Case as Supplied
A 63-year-old man who smoked about 40 pack-years and quit eight years earlier visited an urgent care clinic in January with a week of cough and blood-streaked sputum after a cold. Acute bronchitis was diagnosed and given cough medicine. The patient returned to the primary care clinic in February with the cough and streaking continuing. A chest radiograph was normal, and the diagnosis of bronchitis was confirmed, with a note to return if symptoms persisted. The patient came back in June with weight loss and hoarseness. Computed tomography showed a 3.4-centimeter mass in the left upper lobe with enlarged mediastinal lymph nodes, later confirmed as non-small cell lung cancer at an advanced stage.
The Timeline
Table 1
What Was Known and Decided at Each Visit
| Date | What was known | What was decided | Was another reading available? |
|---|---|---|---|
| January, urgent care | One week of cough with streaked sputum after a cold; former heavy smoker; normal vital signs | Acute bronchitis; symptomatic care | Reasonable at one week; follow-up instructions not documented |
| February, primary care | Five weeks of streaked hemoptysis; former 40-pack-year smoker aged 63; normal examination; normal radiograph | Bronchitis confirmed; return if persists | Yes: persistent hemoptysis with high risk and a normal radiograph warranted computed tomography |
| June, primary care | Weight loss, hoarseness, persistent cough | Computed tomography ordered | Diagnosis made at a later stage |
Note. Note. Composite case constructed for this course.
One Decision Point
The decision that matters is the February visit. In January, after one week of symptoms following a cold, a diagnosis of bronchitis was reasonable, though documented return instructions would have helped. By February, the patient had five weeks of hemoptysis, was 63 and had a 40-pack-year history. Among men in primary care, about one in thirteen who first reported coughing up blood had a respiratory tract cancer diagnosed within three years, and the share rose with age (Jones et al., 2007). In symptomatic patients, roughly a fifth of lung cancers do not show on a plain chest film (Bradley et al., 2019). A clinician reasoning from that information in February had a reading available that pointed to further imaging.
Naming the Bias, With Evidence From the Record
The record suggests two cognitive errors. The first is anchoring: the February note repeats the urgent care diagnosis of bronchitis in its first line and does not mention cancer as a possibility, though the history had changed from one week to five. The second is premature closure, settling on a diagnosis while alternatives are still open: the normal radiograph is recorded with the phrase "no acute process, consistent with bronchitis," treating a test that cannot exclude cancer as if it had. Croskerry (2003) describes both errors as common in diagnosis and notes that they are more likely when a previous diagnosis is carried forward. The record supports these labels; without the note's wording, they would be speculation.
The Ending Against the Reasoning
The outcome, an advanced cancer, does not by itself prove the February decision was wrong; it is possible the cancer was already advanced in February and a scan would not have changed the stage. Judging the decision by the outcome would be hindsight. The decision is open to criticism because of what was known in February, not because of what was found in June: a high-risk patient with persistent hemoptysis and a test known to miss a meaningful share of cancers. A clinician who ordered a scan in February and found nothing would still have reasoned correctly, and the decision should be judged on that basis, not on the result.
A Check That Would Have Fired
A simple rule, built into the clinic's electronic record, would likely have prompted a different decision: when a patient of 50 or over with at least a 20-pack-year history comes in with hemoptysis lasting more than three weeks, a prompt recommends computed tomography even if the chest radiograph is normal. That rule follows published advice to image further in patients with risk factors for malignancy despite a normal radiograph (Earwood & Thompson, 2015). The patient was also eligible for annual screening under current national criteria, which cover adults in their fifties to eighties with a heavy smoking history who quit within the past 15 years (Krist et al., 2021), so a screening reminder would have offered a second chance.
System Contributors
Graber et al. (2005) found that diagnostic errors in internal medicine usually involved both cognitive and system factors. Here, system contributors included the lack of a follow-up appointment after the urgent care visit and the absence of a screening reminder. Fixing only the individual clinician's reasoning would leave those gaps in place.
What a Good February Note Would Have Said
A note that reasoned from the evidence in February might have read: "Five weeks of streaked hemoptysis in a 63-year-old former 40-pack-year smoker. Likely post-viral bronchitis, but persistent symptoms and high risk mean a normal chest radiograph does not exclude malignancy. Ordering CT chest; patient informed of the reason." That note keeps bronchitis as the leading diagnosis, which was reasonable, while recording the must-not-miss diagnosis and acting on it. The difference between that note and the actual one is not knowledge but process: the clinician had to stop and ask what else this could be before accepting the earlier label.
Lessons for My Own Practice
Three lessons carry over to my own work as a future physician assistant. First, when a patient returns with the same complaint, I will restate the problem as if seeing it for the first time, including how long it has lasted, rather than reading the previous diagnosis as settled. Second, I will record what a normal test does and does not exclude, so that the note itself reminds the next reader. Third, I will check screening eligibility at every visit for patients with a heavy smoking history, since screening offers a route to diagnosis that does not depend on symptoms at all. Each lesson is small, and each would have offered a chance to find this cancer earlier. None of them requires more knowledge than the clinicians in this case already had; they require a habit of pausing at a second visit for the same complaint.
References
Bradley, S. H., Abraham, S., Callister, M. E., Grice, A., Hamilton, W. T., Lopez, R. R., Shinkins, B., & Neal, R. D. (2019). Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: A systematic review. British Journal of General Practice, 69(689), e827-e835. https://doi.org/10.3399/bjgp19X706853
Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775-780. https://doi.org/10.1097/00001888-200308000-00003
Earwood, J. S., & Thompson, T. D. (2015). Hemoptysis: Evaluation and management. American Family Physician, 91(4), 243-249.
Graber, M. L., Franklin, N., & Gordon, R. (2005). Diagnostic error in internal medicine. Archives of Internal Medicine, 165(13), 1493-1499. https://doi.org/10.1001/archinte.165.13.1493
Jones, R., Latinovic, R., Charlton, J., & Gulliford, M. C. (2007). Alarm symptoms in early diagnosis of cancer in primary care: Cohort study using General Practice Research Database. BMJ, 334(7602), 1040. https://doi.org/10.1136/bmj.39171.637106.AE
Krist, A. H., Davidson, K. W., Mangione, C. M., Barry, M. J., Cabana, M., Caughey, A. B., Davis, E. M., Donahue, K. E., Doubeni, C. A., Kubik, M., Landefeld, C. S., Li, L., Ogedegbe, G., Owens, D. K., Pbert, L., Silverstein, M., Stevermer, J., Tseng, C.-W., & Wong, J. B. (2021). Screening for lung cancer: US Preventive Services Task Force recommendation statement. JAMA, 325(10), 962-970. https://doi.org/10.1001/jama.2021.1117
PA 503 Week 8 instructions, in plain terms
The final week asks you to analyze a diagnostic error in a supplied case. Build a plain timeline of what was known at each point, what was decided and where another reading was available. Focus the analysis on one decision point rather than the whole course of care. Name any cognitive bias only with evidence from the record, such as wording in a note. Judge decisions against what was known at the time, not against how things turned out. Propose a specific check that would have prompted a different decision. Consider system factors as well as individual reasoning, and finish with what you will do differently in your own practice as a result.
How this PA 503 Week 8 example is built
The case follows a 63-year-old former 40-pack-year smoker seen at urgent care in January with a week of streaked sputum, at primary care in February with five weeks of the same and a normal radiograph, and again in June with weight loss, hoarseness and an advanced cancer on imaging. A table marks February as the visit where another reading was available. Anchoring is evidenced by the February note repeating the earlier diagnosis, and premature closure by the radiograph recorded as consistent with bronchitis. The analysis separates outcome from reasoning, proposes an electronic prompt for computed tomography in high-risk patients, adds missing follow-up and screening reminders and lists three personal habits.
Reading the PA 503 Week 8 grading rubric
A bias named and never evidenced is the single biggest loss, because the label is the easy part and the record work is what the week exists for. Reasoning backward from the ending costs nearly as much: a draft that calls a decision wrong because of how things turned out has judged the outcome, not the reasoning. Timelines that skip what was known, analyses spread across every visit and proposals too vague to act on also lose points. Strong analyses build a clear timeline, focus on one decision, evidence each bias from the record, judge by what was known then, propose a check that would have fired and address system contributors. Ending with specific personal habits shows the lesson was taken.
PA 503 Week 8 help from the desk
Error analyses are uncomfortable, especially when a case resembles one you have seen, and it is easy to slip into blaming the outcome. With the supplied case in hand, we can lay out what was known and decided at each visit, pick the decision point and look for words in the record that evidence a bias. We can also help you design a check that would have prompted a different decision. Conclusions about the error are yours to draw. When an instructor names a classification framework, the custom sample sorts each factor into that framework's categories.
Get a PA-503 Week 8 example written to your instructions
Send the case your section supplied, the required headings and the page limit, and a custom example comes back written to them inside 24 to 48 hours, the first one free. Where a section instead invites an encounter you witnessed yourself, that account stays yours to write, and the desk constructs a case with the same decision structure.
More PA 503 papers and MPAS samples
- PA 503 Week 1: First Question Post
- PA 503 Week 2: Illness Scripts
- PA 503 Week 3: Problem Representation
- PA 503 Week 4: Diagnostic Schema
- PA 503 Week 5: Test Characteristics Problem Set
- PA 503 Week 6: Assessment and Plan Draft
- PA 503 Week 7: Verbal Case Summary
- PA 502 Week 8: Journal Club Brief
- PA 501 Week 8: Professional Commitment Memo
PA 503 Week 8 questions, answered
Does the write-up have to name a specific bias?
Most sections require one and a few accept a described pattern without the label. Either way the evidence requirement is identical: a passage from the record showing the reasoning behaved that way. A named bias with nothing behind it scores below a described pattern that is demonstrated. Send the rubric row and the example matches its wording.
Can we analyze a case that ended well?
Yes, and some sections prefer it, because a good ending strips away the pull of hindsight and leaves the reasoning exposed for inspection. The requirement is a decision point where a different reading was genuinely available on the information at hand. If your assignment insists on a late or missed diagnosis, say so, and the example is constructed under that restriction.
How does the systems part differ from the cognitive part?
The cognitive part explains what happened inside one clinician's reasoning; the systems part explains what allowed it to stand unchallenged. A handover with no second reading, a result nobody was assigned to look at. Sections weight these differently, so send the headings and the example gives each the proportion your rubric asks for.
Where can I find a free PA 503 Week 8 sample paper?
You can read a complete PA 503 Week 8 analysis of a lung cancer diagnosed five months after two bronchitis visits on this page.
What check does the PA 503 Week 8 sample propose?
An electronic prompt recommending computed tomography when a patient aged 50 or older with a heavy smoking history has hemoptysis lasting more than three weeks.