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          When physicians receive a telephone call from a patient at an inconvenient time, they should not let the timing of the phone call dictate their response to the patient’s medical complaints. In a recent New Jersey case, two internists were sued by a patient who suffered a heart attack for providing medical treatment over the telephone without performing a physical examination.


           In that case, the patient had been experiencing a cough with some chest pain during the winter of 1994. One Friday afternoon, the patient developed continuing chest pain after shoveling snow. At that point, his chest pain was no longer related to his cough. He also began perspiring and experienced some shortness of breath. The patient’s wife called her husband’s doctor’s office that afternoon to report his symptoms. The patient’s wife claimed that a female internist took her call and told her that she could not bring her husband into the office because it was going to close at 3 p.m. due to the storm. The female internist also prescribed some cough medicine for the patient over the phone. The patient’s wife claimed that she went out to the pharmacy during the storm to pick up the prescription.


            The female internist denied speaking with the patient’s wife. She claimed she spoke to the patient himself and that he reported only bronchial symptoms. In addition, she claimed that it was the patient who declined to come in for an examination because of the snow storm. However, the female interest’s rendition of the telephone call was not supported by the fact that the plaintiff’s wife actually did go out during the storm to obtain the prescription. In fact, the pharmacy she went to was located near the doctor’s office.


            The patient’s wife claimed that the cough syrup did not help her husband’s symptoms and that she called a second male internist at the same office several times over the weekend. The wife claimed that she reported her husband’s symptoms and asked whether she should take him to the hospital. She also claimed that the male internist told her that the since care provided by the hospital over the weekend was not good, he would not advise her to bring her husband to the hospital. Instead, the wife claims that the male internist prescribed a different cough syrup over the telephone. Although the male internist denied speaking with the patient’s wife over the weekend, his medical records showed that he did call in a prescription to the pharmacy for cough medicine.


            The patient went in to see the male internist at his office the following Monday. At that time, he was diagnosed with bronchitis. The male internist denied that the patient had exhibited cardiac symptoms such as shortness of breath during his Monday examination. Therefore, the defendant did not perform an EKG upon the patient.


            By Tuesday morning, the patient’s medical condition had gotten worse. His wife called an ambulance to bring him to the hospital. Upon his arrival at the hospital, he was diagnosed with an infarct and pulmonary edema. He was then transferred to another hospital for triple bypass surgery.


            The patient and his wife brought a medical malpractice case against both of the physicians who responded to their phone calls during the weekend before the patient’s infarct. The patient claimed that he has significantly reduced cardiac functioning as a result of the defendants’ decision to treat his medical condition over the phone as opposed to treating him in person. The patient claimed that his cardiac damage could have been avoided if his cardiac condition had been treated in a timely manner. The defendant physicians claimed that the patient’s enzyme levels indicated that his infarct did not actually begin until Tuesday. In addition, since the patient had a history of diabetes, elevated cholesterol, and coronary artery disease, it was undisputed that he would have inevitably required bypass surgery regardless of when his condition had been diagnosed.


            The jury found that only the female internist was negligent. The jury granted the patient $500,000 in damages. However, this damage award was reduced by 55% because the jury also attributed some of the patient’s damages to his underlying medical condition.


            Based upon the New Jersey trial court’s decision, doctors should be aware that the standard of care is not dependant upon the time of day a patient is seeking treatment. A patient who calls with complaints during a snow storm or during a weekend or holiday is entitled to the same treatment as a patient who complains during regular office hours. In addition, physicians should be careful about prescribing medication over the telephone. Telephone prescriptions may not actually help a patient and may give them a false sense of security that their condition is improving. Finally, a physician who chooses to treat a patient over the telephone without a prior physical exam often appears to jurors as a non-caring physician. This perception can make defending potential medical malpractice cases difficult.


Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration

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Providing Medical Advice on the Phone

by Attorney Frank E. Reardon

August 1999