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
Cross River State, Nigeria
Phone No.
+234 (0) 8063600642
Visit
Website: www.hriwestafrica.com
E-mail: hriwestafrica@gmail.com
E-mail: hriwestafrica@gmail.com
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
Cross River State, Nigeria
Phone No.
+234 (0) 8063600642
Joseph Ana has a cumulative continuous practice experience of over 40-years in
Nigeria, United Kingdom and Ghana as a Primary Health Care Physician, Public
Health Expert, General and Urological Surgeon, Health Policy Expert and
Implementer, Medical Educator and Trainer..
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