CINCINNATI -- How could cancer be mistaken for teenage acne? A Florida family says that is exactly what happened to them after a visit to the emergency room.
Now the Hyatt family worries what happened to their son will happen again.
Like so many other high schoolers Joseph Hyatt loves video games and baseball. Unlike most his age, Joseph faces a second showdown with cancer at 17.
His mom, Teresa Hyatt, said they would not have caught the cancer early had the family listened to the emergency room doctor.
Joseph discovered the lump about half the size of a golf ball behind his ear on a Saturday night in June. To understand why a lump would send the Hyatts straight to the ER, one would have to know their history and heartbreak.
Various cancers wiped out half of Teresa's family within six years. A brother died of bone cancer at the age of 50. Teresa’s mother and father followed him in death. Then the disease turned its sights on Teresa's sister. And just last year, another bombshell: Joseph was diagnosed with melanoma on his head.
That night in St. Joseph’s Riverview emergency room, Teresa said she relayed Joseph's melanoma and the family's cancer losses to both the nurse and the doctor. The family claims both a nurse and doctor looked at the lump and within minutes diagnosed it as teen acne.
Joseph's discharge papers included instructions for treating acne and a suggestion they follow up with his primary care physician.
Dr. Jay Wolfson, associate vice president of USF Health, points out ER doctors often do not have the training it takes to diagnose cancer.
One study conducted between 2007 and 2013 showed the top claim against emergency department doctors was "failure to diagnose." Dr. Steve Feagins of Mercy Health said where a person should seek treatment depends on the issue.
Emergent problems should get emergency department attention.
"They're going to treat that sudden thing," Feagins said.
In a case involving a family history of something like cancer, that might not change how an emergency department doctor, looking to handle the here-and-now, approaches that more chronic concern, according to Feagins.
"That requires a continuity of care, a specialist," he said.
Feagins said it's best to always have a medical home: a primary care physician. If you end up in the emergency department, treat it like just an episode of care on a bigger continuum.
"Every time you leave any doc's office in the emergency department, you should have your follow-up plan," he said. "You should know, 'what am I doing next?' Where, who and how.'"
In The Hyatts' case a mother's instinct proved to be a life saver. Teresa took Joseph to his primary care physician two days after leaving the emergency room. The family doctor sent the Hyatts to Shands Cancer Hospital for a biopsy. That lump dismissed as a pimple turned out to be Hodgkin lymphoma.
The biopsy took care of the tumor, but not all of the cancer cells. Joseph now faces another surgery.
After a reporter's inquiry, the head of St. Joseph's Riverview Emergency Room contacted the family. Then a hospital spokesperson sent this statement:
“ERs are designed for true medical emergencies and they focus on treating people who have been seriously injured or are gravely ill and in a lot of pain.”
While the Hyatts focus on the fight ahead, they plan to share their story with anyone who will listen.