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Doctors who are named defendants in medical malpractice cases based on failure to make timely diagnoses, often complain that the plaintiff’s lawyer had the benefit of hindsight that they lacked. A review of cases of late diagnosis, however, shows that the real culprit was often a lack of curiosity by the physician. The best doctors are medical detectives and like the best detectives, they will recognize important clues and follow them until they understand their significance. Understanding the significance of medical clues is especially important, because in some cases, responding late may be as deadly as not responding at all; late diagnosis may be as dangerous as misdiagnosis.

Two cases from my own practice illustrate the dangers of a lackadaisacal approach to clues from a patient’s body that something may be seriously wrong. In one case, an internist dismissed two cases of unexplained hematochezia (blood in the stool) with the comment in the records, “I don’t think anything is going on here,” a conclusion reached without ordering sufficient tests to make sure that his instinct was correct. It was not. The hematochezia was being caused by early colon cancer, which metastacized by the time it was discovered. The patient ultimately died from the cancer – a cancer misdiagnosis death that was truly avoidable.

In another case, a neurologist examining a patient who suffered a recent stroke, suspected severely narrowed carotid arteries as a cause, but did not order tests to confirm her suspicion on an urgent basis. Before she could act on test results showing the patient was severely stenosed and at high risk for a subsequent stroke, he suffered a massive, disabling stroke, one that could have been prevented with timely action. A Massachusetts arbitrator recently awarded nearly $1,000,000 to the family of a teenager who died of an aggressive post-injury arm infection – the treating nurse and physician failed to act quickly enough on troubling blood culture results. Many aches, pains and other symptoms, are harmless. Some, though, are known to be potentially linked to serious conditions – chest pain or double-vision, for example – and cannot be ignored. A doctor must know the difference. Owning the attitude of a medical detective increases the likelihood of the best of patient care.

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