An article in today’s Wall Street Journal discusses the failure of physicians to consider and communicate abnormal test results and the prevalence generally of diagnostic errors, which account for approximately 40% of all malpractice claims and cost “insurers an average of $300,000 per case to settle.” The article continues by citing data from a variety of studies that primary care doctors are “overwhelmed” by test resultabnormalities that are not communicated to their patients or are otherwise discounted as within the margin of laboratory error and are not given indepedentsignificance.
One study conducted by the Veterans Health Administration found that when a primary care doctor and a specialist both get test results, each assumes the other will follow up with the patient and the end result is no communication with the patient at all. A perfect example of a disaster waiting to happen is a male patient who sees a primary care doctor and a urologist for complaints associated with an enlarged prostate, a commonly experienced problem in men over 50. Sometimes the urologist may order blood work, while at other times he may rely on a patient’s representation that his primary care doctor already ran blood work months earlier and reported no abnormalities. The urologist will sometimes rely on the patient’s report of normal results andwill not ask theprimary care doctor for theresults.
A standard test for male patients over the age of 40 is the “Prostate Specific Antigen” test or PSA. While primary care physicians may focus on results that fall outside certain numeric thresholds established by the lab as abnormal (typically +2.5-4 ng/ml), urologists are more concerned with the “velocity” of PSA increase from one test result to another even if the results are outside the abnormal parameters for the patient’s age.If the urologist doesn’t have all the test results, he will never be in a position to consider the full extent of the PSA velocity which can result in a disastrous failure to diagnose prostate cancer, the 2ndleading cause of male death in the United States.
There are many other examples that result in failure of physicians to coordinate and diagnose major medical problems due to erroneous assumptions and pure failures to coordinate and communicate with other treating physicians.
Patients who believe no news is good news and who are anxious to learn their results need to be their own best advocates and call for test results and insist on answers and information no matter what the doctor’s temperament or attitude. They should get copies of all test results from all of their doctors, and ensure thattheir other doctors receive the same results.
From a purely practical standpoint, if a doctor is impossible to get a hold of or has a disinterested attitude, the patient should run and not walk away from that doctor and choose a provider who is compassionate, caring, and has a manageablepatient load. Sitting in the waiting room, watching the length of time it takes to see the doctor after arrival for the consultation, and the time the doctor spends with the patient during the visit are all good indicators of the doctor’s patient load but are not conclusive. Some physicians are great at small talk, but when they don’t know what’s in the patient’s chart or ask basic questions about the patient’s health that they should otherwise know from reading the chart in advance of the consultation, these are ominous signs that should be heeded.
The point of all this is that malpractice claims arising from doctor oversight of diagnostic information is prevalent and can be avoided by efforts on both sides of the physician-patient relationship. Patients need to ask questions, call their physicians, seek prompt care, not wait for their symptoms to disappear, follow physician instructions to get tested, and comply with their physicians’ prediagnostic instructions for test and procedure preparation. Likewise, physicians must communicate with their patients, pay attention to test results, consider the patient’s clinical symptoms, not simply discount abnormalities as within “the margin of laboratory error” and coordinate patient care with other specialists who are involved.
Medical malpractice claims serve a deterrent effect against negligent medical care and also arguably result in the practice of defensive medicine where unnecessary tests and procedures are performed out of fear that something will be missed and the doctor will be sued. Although healthcare costs are at the forefront of the public debate, a recent Harvard study findsthat malpractice claims and defensive medical care represent a very minimal part of the overall healthcare costs in the United States. If the choice is defensive medicine over better and more careful healthcare, the choice seems self-evident.
Belsky, Weinberg & Horowitz understands the issues patients are faced with and the results of improper medical care. We have a team of highly trained and credentialed lawyers and a support staff whose track record for excellent results and client compassion make the difference in claim outcomes. Please contact us if you are considering a claim, or simply if you are confused over the course of your healthcare. Although we are not physicians, we can guide you in the right direction to get the answers you need and deserve. We will offer our advice in the hope we can help just one person avoid a malpractice claim.