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These physicians did not mention the results of the x rays in their notes nor did they inform the patient of the abnormal findings. Two years later, the patient had retained an attorney to represent him in an unrelated personal injury matter. By that time, the patient had been diagnosed with lung cancer. The diagnosis was made after the plaintiff complained of a persistent cough and coughing up blood. A tumor measuring 10 cm. By 7 cm. Was found in the left lung. The tumor was resected but the cancer had metastasized to the brain. In reviewing the patient’s records from the 1995 back surgery, the attorney discovered the abnormal chest x rays and subsequently initiated a malpractice suit against the orthopedic surgeon, the resident, the primary care physician and the hospital. Prior to trial, the surgeon settled the case for the limits of his liability policy, $2000000. The remaining defendants went to trial.
All of the defendants acknowledged that the standard of care required follow up based upon the results of the chest x rays. They also acknowledged that none of them had informed the patient of these results. The plaintiff alleged that the resident was negligent for failing to include information about the radiology reports in his admitting papers or discharge summary. He also alleged that the surgeon and the primary care doctor were negligent in failing to be review these reports and be aware of the abnormal findings. The resident asserted that the surgeon was aware of the results and that it was his responsibility to deal with this information. The primary care physician argued that it was the responsibility of the surgeon or the radiologist to insure that appropriate follow up was attained.
The jury returned a verdict of $14 million dollars. The jury apparently did not agree with the defense that the sole responsibility for following through on this information rested with the surgeon who had already settled out of the case.
This case raises a number of issues. First of all, when tests are ordered, a patient will reasonably assume that the physician who ordered the test will review all of the results. Thus, even thought the chest x rays cleared the patient for surgery, the jury expected that the abnormal findings would be pursued. The question in this case then became which caregiver had the responsibility of providing follow up care. Clearly, everyone in this case was attempting to blame the orthopedic surgeon for this failure, as he was the one ordering the test and therefore, was responsible for the results. Juries do not often differentiate the lines of responsibility this closely, however. The patient had a very serious finding on the exam and the jury expected one or all of these physicians to be vigilant in the care of the patient and carefully review such information. Inevitably, a juror will look at the case through their own eyes and expect that, if they found themselves in a like situation, their doctor would be caring and sufficiently careful to prevent this type of oversight from occurring. Thus, they are more likely to impose the burden of responsibility on each of them rather than singling out one of them. The defense of blaming the other caregiver is risky at best when such information is in the medical record and simple communication would likely have resolved the problem. Indeed, in this case, there was considerable evidence that if the cancer had been diagnosed two years earlier, the impact upon the patient’s life would have been much less extreme.
Perhaps the most significant concern of patients today is that health care has become impersonal. In the view of many, the relationship between the provider and the patient is simply not as close and thoughtful as it once was.
This perception fosters the notion that physicians are more concerned with completing their role in treating the patient rather than being concerned with the care of the whole patient. When jurors see an example of this trend, they are likely to become incensed and render an award that matches their disappoint with such conduct.
To counter such concerns, physicians need to communicate with one another in an established, cohesive fashion. Tests results need to be communicated in a way that insure that abnormal findings are brought to the attention of the appropriate people. Modes of communications between the specialist and the referring physician need to be delineated and records of this communication need to be maintained. Finally, careful and thoughtful review of such abnormal findings needs to take place with the patient and systems need to be in place to insure that the patient hears the advice and reaches an informed decision about what course of treatment to pursue.
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