CLINICAL GOVERNANCE - 'Fatal Outcome After Clinician Prescribes Without Seeing Patient' - Health Resource International West Africa (HRI)

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Monday, 9 October 2017

CLINICAL GOVERNANCE - 'Fatal Outcome After Clinician Prescribes Without Seeing Patient'

Dear All,
Nigeria is the only country on this earth without a medical and dental council for two years at a strectch so we share below , courtesy of Doximity, an educating case story for all of us to learn from and take heed:

A number of strong points emerge - ask yourself, if you were Dr V, do you have a medical defence organisation to call on for help?. Do you have a medical defence legal counsel to call on? And how up-to-date are you with your CPD/CME?
READ ON:
'Fatal Outcome After Clinician Prescribes Without Seeing Patient
 Monthly Prescribing Reference · October 2, 2017Original Article Fatal Outcome After Clinician Prescribes Without Seeing Patient
 Dear All,
Nigeria is the only country on this earth without a medical and dental council for two years at a strectch so we share below , courtesy of Doximity, an educating case story for all of us to learn from and take heed:
A number of strong points emerge - ask yourself, if you were Dr V, do you have a medical defence organisation to call on for help?. Do you have a medical defence legal counsel to call on? And how up-to-date are you with your CPD/CME?

READ ON:

'Fatal Outcome After Clinician Prescribes Without Seeing Patient

Monthly Prescribing Reference · October 2, 2017Original Article Fatal Outcome After Clinician Prescribes Without Seeing Patient

Monthly Prescribing Reference · October 2, 2017Original Article 
This month's case examines what could happen when a clinician diagnoses and prescribes based on complaints being relayed to her, without seeing, or even directly speaking to, the patient.
Dr. V was a family practitioner with a very busy small practice. The 55-year-old physician employed a receptionist to staff the front desk and answer the phones, and a medical assistant to prep patients and take vitals.
One of the physician's patients was Mrs. C, 69. The patient had been seeing Dr. V for the past four years for hypertension, asthma, osteoporosis, COPD, urinary tract infections, and allergic rhinitis. The patient, who was obese and had trouble getting around, came in with frequent complaints, most recently in early May for a sprained ankle.
On July 7th, as the physician was preparing to step into an exam room, her receptionist flagged her down.
“Mrs. C is on the phone,” said the receptionist. “She says that she's experiencing a burning sensation upon urinating. Should she come in?”
The doctor glanced at her schedule. There was no time to squeeze Mrs. C in, and the physician knew that it was difficult for the patient to get to the office.
“Tell her that I'll call in a prescription for Cipro to treat her UTI,” said Dr. V, and she directed the receptionist to note the call, the complaint, and the fact a 7-day course of antibiotics had been prescribed to treat the infection, in the patient's record.
Two weeks later, on July 22, the receptionist caught the physician as she was between patients.
“Mrs. C called again while you were with a patient,” said the receptionist. “She said she has a bad cough and was coughing up mucus.”
The physician again looked at the schedule, sighed, and told the receptionist to call the patient back and advise her that the doctor would be calling in a prescription for a 10-day course of Ceftin, and Tussionex. The receptionist noted this in the file, and called the patient to advise her.
On July 28th, Mrs. C called the office again, this time complaining that she was not feeling better and that she had developed a slight fever. Again, the patient spoke only to the receptionist, who conveyed the message to the physician. This time the physician prescribed Tessalon Perles and recommended that the patient continue the antibiotics. (This information was again conveyed by the receptionist to the patient, and again the receptionist noted the content of the conversation with the patient, and the physician's recommendations in the file.)
The following day, July 29th, the patient called the physician's office again to report gas pain and loose bowel movements. Dr. V, via the receptionist, told the patient to discontinue the Ceftin, and that she would call in a five-day course of Cipro instead. The patient was also advised to take Immodium.
This was the last time that anyone at the physician's office would speak to Mrs. C. Two days later, the patient presented to the emergency department of her local hospital with symptoms of diarrhea and a low-grade fever. She was found to be hypotensive and dehydrated. Lab studies indicated an elevated white blood cell count and hyponatremia. The patient was admitted to rule out sepsis, colitis, or diverticulitis. An imaging study showed what was believed to be an ileus in the small bowel. Stool cultures revealed antibiotic-induced C. difficile bacteria. The consulting surgeon believed that the patient had pseudomembranous colitis secondary to C. difficile infection. The patient's condition continued to worsen, and on August 3rd she was taken for exploratory surgery. The surgeon resected a large segment of ischemic distal ileum, but described the colon as normal in appearance. After surgery, the patient's condition continued to worsen and after life support measures were discontinued, the patient died.
The patient's distraught husband contacted a plaintiff's attorney who, after hearing the facts, accepted the case and filed a lawsuit against Dr. V, alleging that she negligently failed to see the patient on July 28th and 29th, and failed to diagnose C. difficile colitis that led to the patient's death.
When Dr. V was notified about the lawsuit, she contacted the defense attorney provided by her medical malpractice insurance. The attorney was concerned after reading the file and speaking to the physician. He retained several medical experts to look at the patient's records.
All of the medical experts were critical of Dr. V and felt that she should have seen the patient on July 28th or 29th when she called reporting no improvement in her symptoms and new-onset diarrhea. Failure to see the patient in the office at this point was a below the standard of care, agreed the experts. The case inched towards trial. During depositions, Dr. V testified that antibiotic-induced C. difficile infection was “not on her radar” with respect to the patient's telephone complaints.
Trial began, but a settlement was soon negotiated and the insurance company made a payment on behalf of Dr. V to settle the case.

This month's case examines what could happen when a clinician diagnoses and prescribes based on complaints being relayed to her, without seeing, or even directly speaking to, the patient.
Dr. V was a family practitioner with a very busy small practice. The 55-year-old physician employed a receptionist to staff the front desk and answer the phones, and a medical assistant to prep patients and take vitals.
One of the physician's patients was Mrs. C, 69. The patient had been seeing Dr. V for the past four years for hypertension, asthma, osteoporosis, COPD, urinary tract infections, and allergic rhinitis. The patient, who was obese and had trouble getting around, came in with frequent complaints, most recently in early May for a sprained ankle.
On July 7th, as the physician was preparing to step into an exam room, her receptionist flagged her down.
“Mrs. C is on the phone,” said the receptionist. “She says that she's experiencing a burning sensation upon urinating. Should she come in?”
The doctor glanced at her schedule. There was no time to squeeze Mrs. C in, and the physician knew that it was difficult for the patient to get to the office.
“Tell her that I'll call in a prescription for Cipro to treat her UTI,” said Dr. V, and she directed the receptionist to note the call, the complaint, and the fact a 7-day course of antibiotics had been prescribed to treat the infection, in the patient's record.
Two weeks later, on July 22, the receptionist caught the physician as she was between patients.
“Mrs. C called again while you were with a patient,” said the receptionist. “She said she has a bad cough and was coughing up mucus.”
The physician again looked at the schedule, sighed, and told the receptionist to call the patient back and advise her that the doctor would be calling in a prescription for a 10-day course of Ceftin, and Tussionex. The receptionist noted this in the file, and called the patient to advise her.
On July 28th, Mrs. C called the office again, this time complaining that she was not feeling better and that she had developed a slight fever. Again, the patient spoke only to the receptionist, who conveyed the message to the physician. This time the physician prescribed Tessalon Perles and recommended that the patient continue the antibiotics. (This information was again conveyed by the receptionist to the patient, and again the receptionist noted the content of the conversation with the patient, and the physician's recommendations in the file.)
The following day, July 29th, the patient called the physician's office again to report gas pain and loose bowel movements. Dr. V, via the receptionist, told the patient to discontinue the Ceftin, and that she would call in a five-day course of Cipro instead. The patient was also advised to take Immodium.
This was the last time that anyone at the physician's office would speak to Mrs. C. Two days later, the patient presented to the emergency department of her local hospital with symptoms of diarrhea and a low-grade fever. She was found to be hypotensive and dehydrated. Lab studies indicated an elevated white blood cell count and hyponatremia. The patient was admitted to rule out sepsis, colitis, or diverticulitis. An imaging study showed what was believed to be an ileus in the small bowel. Stool cultures revealed antibiotic-induced C. difficile bacteria. The consulting surgeon believed that the patient had pseudomembranous colitis secondary to C. difficile infection. The patient's condition continued to worsen, and on August 3rd she was taken for exploratory surgery. The surgeon resected a large segment of ischemic distal ileum, but described the colon as normal in appearance. After surgery, the patient's condition continued to worsen and after life support measures were discontinued, the patient died.
The patient's distraught husband contacted a plaintiff's attorney who, after hearing the facts, accepted the case and filed a lawsuit against Dr. V, alleging that she negligently failed to see the patient on July 28th and 29th, and failed to diagnose C. difficile colitis that led to the patient's death.
When Dr. V was notified about the lawsuit, she contacted the defense attorney provided by her medical malpractice insurance. The attorney was concerned after reading the file and speaking to the physician. He retained several medical experts to look at the patient's records.
All of the medical experts were critical of Dr. V and felt that she should have seen the patient on July 28th or 29th when she called reporting no improvement in her symptoms and new-onset diarrhea. Failure to see the patient in the office at this point was a below the standard of care, agreed the experts. The case inched towards trial. During depositions, Dr. V testified that antibiotic-induced C. difficile infection was “not on her radar” with respect to the patient's telephone complaints.
Trial began, but a settlement was soon negotiated and the insurance company made a payment on behalf of Dr. V to settle the case.'
Joseph Ana
Africa Center for Clin Gov Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals 
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria
Phone No. +234 (0) 8063600642
Monthly Prescribing Reference · October 2, 2017Original Article 
This month's case examines what could happen when a clinician diagnoses and prescribes based on complaints being relayed to her, without seeing, or even directly speaking to, the patient.
Dr. V was a family practitioner with a very busy small practice. The 55-year-old physician employed a receptionist to staff the front desk and answer the phones, and a medical assistant to prep patients and take vitals.
One of the physician's patients was Mrs. C, 69. The patient had been seeing Dr. V for the past four years for hypertension, asthma, osteoporosis, COPD, urinary tract infections, and allergic rhinitis. The patient, who was obese and had trouble getting around, came in with frequent complaints, most recently in early May for a sprained ankle.
On July 7th, as the physician was preparing to step into an exam room, her receptionist flagged her down.
“Mrs. C is on the phone,” said the receptionist. “She says that she's experiencing a burning sensation upon urinating. Should she come in?”
The doctor glanced at her schedule. There was no time to squeeze Mrs. C in, and the physician knew that it was difficult for the patient to get to the office.
“Tell her that I'll call in a prescription for Cipro to treat her UTI,” said Dr. V, and she directed the receptionist to note the call, the complaint, and the fact a 7-day course of antibiotics had been prescribed to treat the infection, in the patient's record.
Two weeks later, on July 22, the receptionist caught the physician as she was between patients.
“Mrs. C called again while you were with a patient,” said the receptionist. “She said she has a bad cough and was coughing up mucus.”
The physician again looked at the schedule, sighed, and told the receptionist to call the patient back and advise her that the doctor would be calling in a prescription for a 10-day course of Ceftin, and Tussionex. The receptionist noted this in the file, and called the patient to advise her.
On July 28th, Mrs. C called the office again, this time complaining that she was not feeling better and that she had developed a slight fever. Again, the patient spoke only to the receptionist, who conveyed the message to the physician. This time the physician prescribed Tessalon Perles and recommended that the patient continue the antibiotics. (This information was again conveyed by the receptionist to the patient, and again the receptionist noted the content of the conversation with the patient, and the physician's recommendations in the file.)
The following day, July 29th, the patient called the physician's office again to report gas pain and loose bowel movements. Dr. V, via the receptionist, told the patient to discontinue the Ceftin, and that she would call in a five-day course of Cipro instead. The patient was also advised to take Immodium.
This was the last time that anyone at the physician's office would speak to Mrs. C. Two days later, the patient presented to the emergency department of her local hospital with symptoms of diarrhea and a low-grade fever. She was found to be hypotensive and dehydrated. Lab studies indicated an elevated white blood cell count and hyponatremia. The patient was admitted to rule out sepsis, colitis, or diverticulitis. An imaging study showed what was believed to be an ileus in the small bowel. Stool cultures revealed antibiotic-induced C. difficile bacteria. The consulting surgeon believed that the patient had pseudomembranous colitis secondary to C. difficile infection. The patient's condition continued to worsen, and on August 3rd she was taken for exploratory surgery. The surgeon resected a large segment of ischemic distal ileum, but described the colon as normal in appearance. After surgery, the patient's condition continued to worsen and after life support measures were discontinued, the patient died.
The patient's distraught husband contacted a plaintiff's attorney who, after hearing the facts, accepted the case and filed a lawsuit against Dr. V, alleging that she negligently failed to see the patient on July 28th and 29th, and failed to diagnose C. difficile colitis that led to the patient's death.
When Dr. V was notified about the lawsuit, she contacted the defense attorney provided by her medical malpractice insurance. The attorney was concerned after reading the file and speaking to the physician. He retained several medical experts to look at the patient's records.
All of the medical experts were critical of Dr. V and felt that she should have seen the patient on July 28th or 29th when she called reporting no improvement in her symptoms and new-onset diarrhea. Failure to see the patient in the office at this point was a below the standard of care, agreed the experts. The case inched towards trial. During depositions, Dr. V testified that antibiotic-induced C. difficile infection was “not on her radar” with respect to the patient's telephone complaints.
Trial began, but a settlement was soon negotiated and the insurance company made a payment on behalf of Dr. V to settle the case.

This month's case examines what could happen when a clinician diagnoses and prescribes based on complaints being relayed to her, without seeing, or even directly speaking to, the patient.
Dr. V was a family practitioner with a very busy small practice. The 55-year-old physician employed a receptionist to staff the front desk and answer the phones, and a medical assistant to prep patients and take vitals.
One of the physician's patients was Mrs. C, 69. The patient had been seeing Dr. V for the past four years for hypertension, asthma, osteoporosis, COPD, urinary tract infections, and allergic rhinitis. The patient, who was obese and had trouble getting around, came in with frequent complaints, most recently in early May for a sprained ankle.
On July 7th, as the physician was preparing to step into an exam room, her receptionist flagged her down.
“Mrs. C is on the phone,” said the receptionist. “She says that she's experiencing a burning sensation upon urinating. Should she come in?”
The doctor glanced at her schedule. There was no time to squeeze Mrs. C in, and the physician knew that it was difficult for the patient to get to the office.
“Tell her that I'll call in a prescription for Cipro to treat her UTI,” said Dr. V, and she directed the receptionist to note the call, the complaint, and the fact a 7-day course of antibiotics had been prescribed to treat the infection, in the patient's record.
Two weeks later, on July 22, the receptionist caught the physician as she was between patients.
“Mrs. C called again while you were with a patient,” said the receptionist. “She said she has a bad cough and was coughing up mucus.”
The physician again looked at the schedule, sighed, and told the receptionist to call the patient back and advise her that the doctor would be calling in a prescription for a 10-day course of Ceftin, and Tussionex. The receptionist noted this in the file, and called the patient to advise her.
On July 28th, Mrs. C called the office again, this time complaining that she was not feeling better and that she had developed a slight fever. Again, the patient spoke only to the receptionist, who conveyed the message to the physician. This time the physician prescribed Tessalon Perles and recommended that the patient continue the antibiotics. (This information was again conveyed by the receptionist to the patient, and again the receptionist noted the content of the conversation with the patient, and the physician's recommendations in the file.)
The following day, July 29th, the patient called the physician's office again to report gas pain and loose bowel movements. Dr. V, via the receptionist, told the patient to discontinue the Ceftin, and that she would call in a five-day course of Cipro instead. The patient was also advised to take Immodium.
This was the last time that anyone at the physician's office would speak to Mrs. C. Two days later, the patient presented to the emergency department of her local hospital with symptoms of diarrhea and a low-grade fever. She was found to be hypotensive and dehydrated. Lab studies indicated an elevated white blood cell count and hyponatremia. The patient was admitted to rule out sepsis, colitis, or diverticulitis. An imaging study showed what was believed to be an ileus in the small bowel. Stool cultures revealed antibiotic-induced C. difficile bacteria. The consulting surgeon believed that the patient had pseudomembranous colitis secondary to C. difficile infection. The patient's condition continued to worsen, and on August 3rd she was taken for exploratory surgery. The surgeon resected a large segment of ischemic distal ileum, but described the colon as normal in appearance. After surgery, the patient's condition continued to worsen and after life support measures were discontinued, the patient died.
The patient's distraught husband contacted a plaintiff's attorney who, after hearing the facts, accepted the case and filed a lawsuit against Dr. V, alleging that she negligently failed to see the patient on July 28th and 29th, and failed to diagnose C. difficile colitis that led to the patient's death.
When Dr. V was notified about the lawsuit, she contacted the defense attorney provided by her medical malpractice insurance. The attorney was concerned after reading the file and speaking to the physician. He retained several medical experts to look at the patient's records.
All of the medical experts were critical of Dr. V and felt that she should have seen the patient on July 28th or 29th when she called reporting no improvement in her symptoms and new-onset diarrhea. Failure to see the patient in the office at this point was a below the standard of care, agreed the experts. The case inched towards trial. During depositions, Dr. V testified that antibiotic-induced C. difficile infection was “not on her radar” with respect to the patient's telephone complaints.
Trial began, but a settlement was soon negotiated and the insurance company made a payment on behalf of Dr. V to settle the case.'
Joseph Ana
Africa Center for Clin Gov Research & Patient Safety
@ HRI West Africa Group - HRI WA
Consultants in Clinical Governance Implementation
Publisher: Health and Medical Journals 
8 Amaku Street Housing Estate, Calabar
Cross River State, Nigeria
Phone No. +234 (0) 8063600642


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