There are no specific guidelines that any physician or medical provider is required to follow. Imagine the complexity of decision making in with all of the variations of various clinical presentations and medical histories. Depending on the setting, it is highly dependent on how a practioner might approach a presentation. In the ER I refer to it as "bottom-up" medicine. You assume the worst possible case, ruling things out as you go. You may or may not actually fully treat the presentation, but you have ruled out that the person is in mortal peril. In Family Practice however you often go with the MOST LIKELY case, expecting that if symptoms get worse the patient will return or go to the ER. We all want affordable healthcare. We ask our medical professionals to see 40-50 patients a day. We do not want unneccessary tests. Well all of that comes to a crashing halt the moment something goes wrong. Regardless of the work load, I do not know of a caring medical professional that would omit an important part of the diagnostic process because he/she was too busy, knowing that it might jeopardize his/her patient. Doctors cam make honest errors too. I am not endorsing necessarily what the practioner did or did not do, but I know there are plenty of cases of bronchitis that I have diagnosed without getting a chest xray. The example you provide does not exclude the idea that the patient had BOTH bronchitis and CHF. I can imagine several circumstances where patients can exhibit flash pulmonary edema and decompensate substantially in a few hours time - let alone two days. If this is someone you know or a family member, I am sorry for your loss. It is natural to look for someone to blame when things go badly. Unfortunately sometimes things look much more obvious in retrospect. If you feel like this practioner is really uncaring or is unconcerned or frankly is incompetent, then it would be wise to find another provider. If you think he/she is a good provider that made a mistake, I probably would stick with them. Good luck.