Malpractice Case: The Perils of One-Way Communications

Gordon T. Ownby


May 09, 2018

Medscape Editor’s Key Points

  • When a patient's medical news and circumstances appear critical, everyone involved in the patient's care should discuss the case and report their findings in order to formulate an appropriate treatment plan in a timely manner.

  • A physician faxed the patient's reports to the referring primary care physician late in the workday on two separate days, instead of placing a phone call to discuss critical findings.

The Case

Fax, email, texting, voicemail: There is no shortage of ways to keep in touch with one another these days. When the medical news is significant, however, there is still no substitute for physicians talking to one another.

A 37-year-old man with a history of radiation-treated lymphoma complained to his primary care physician, Dr PC, of intermittent left eye tunnel vision, recent migraine headaches, increased sensitivity to light, a painful left face and jaw, and white spots in his left eye. The patient told Dr PC that he had recently been seen by his ophthalmologist, who recommended that he undergo a carotid artery scan. Dr PC and the patient discussed the possibility that he was suffering from ocular migraine headaches.

The patient called a week later to report worsening headaches and blurry vision and to ask for a referral to a neurologist. Dr PC referred him to a neurologist, and though the record is unclear as to the date of the referral, Dr PC sent the patient to get a Doppler carotid scan.

At his exam the next day, the neurologist, Dr N, noted the patient's signs and symptoms of migraines, history of Hodgkin's disease with radiation to the neck, and the artery scan to be conducted the next day. Dr N gave the patient samples of a migraine medication, requested an MRI of the brain with contrast, and asked that the patient call him the next day with an update.

The patient appeared the next day for the Doppler carotid scan. The technician who performed the exam had the radiologist, Dr R, review it immediately. The patient was released without Dr R speaking to him on his findings.

In his preliminary reading that day, Dr R noted that the right and left common carotid arteries were occluded, as was the right internal carotid artery. The left internal carotid artery had significant narrowing. Dr R had the report sent by fax to Dr PC late in the workday. The next day, a Friday, Dr R confirmed the findings in his final report, which he also sent by fax to Dr PC in the late afternoon.

Dr R did not call Dr PC on either occasion.

That same Friday, the patient's CT scan of the head (not performed by Dr R) showed a left frontal white matter signal abnormality, with further evaluation recommended. That report was faxed to Dr PC the next Tuesday.

On Monday, however, the patient contacted Dr PC. Dr PC noted Dr R's report on the artery occlusions and put in a request that the patient get a CT angiogram.

On Tuesday, however, the patient suffered a significant stroke.

The patient sued Dr PC, Dr N, and Dr R for negligence. His attorneys contended not only that the defendants failed to timely act on "ominous" findings, but also that there was "insufficient, inappropriate, and improper communication" among the physicians. "Neither Dr PC, Dr N, nor Dr R timely or appropriately communicated with each other to formulate an appropriate plan after (Thursday)."

Dr R resolved the case with the patient prior to trial.

Certainly juries and arbitrators understand that physicians of different specialties have different approaches and protocols in guarding their patients' health.

However, when the circumstances appear critical, jurors will expect these specialists to talk to one another. The power of conversation is, after all, the potential for a thought to develop that would not have occurred to one person alone.

This case comes from Medicine on Trial, originally published by Cooperative of American Physicians, Inc., to provide risk management lessons from litigated case histories.


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