Physicians cannot do everything in the medical office, but being directly involved in critical communications can provide further protection against a medical error.
A middle-aged schoolteacher visited Dr. OTO, an otolaryngologist, for a sore on her tongue that was causing her slight discomfort. The patient was on Synthroid and used nasal sprays, but described her health as good. Dr. OTO wrote “leukoplakia tongue” in the diagnosis section of his chart and took a biopsy.
The pathologist described his finding as chronic mucositis with mucosal acanthosis and keratinocyte atypia. He wrote he “cannot not rule out mild dysplasia,” but “no in situ or invasive malignancy is identified.” In the comments section, the pathologist noted, “In the area of possible dysplasia the specimen is fragmented making assessment difficult. Clinical correlation is necessary.”
A stamped area of the pathology report confirmed Dr. OTO’s review of the report. A checked box described the report as “abnormal.”
A handwritten note on the pathology report dated five days later, however, described a telephone call from Dr. OTO’s office staff: “Spoke with patient at 6 p.m. and she was informed that biopsy was negative for irritation.” Another piece of handwriting on the pathology report indicated “follow up two months.”
Also that evening, Dr. OTO’s office called the patient’s pharmacy with a prescription for Kenalog Orabase, to be applied to affected area twice daily for four weeks.
The patient did not return to Dr. OTO, but just over three months later she returned to her internist for her tongue pain, elbow pain, and other complaints. The internist referred her to an oral medicine specialist, whom the patient saw five weeks later. In the interim, the patient saw a dentist, who also referred her to the same oral medicine specialist, Dr. OM.
Based on an examination and a new biopsy report, Dr. OM referred the patient to an oral surgeon at a major medical center. A pathologist at the medical center reviewed Dr. OM’s biopsy and diagnosed “invasive keratinizing squamous cell carcinoma, moderate to poorly differentiated.” A pathology report from the ensuing surgery showed that 2/16 lymph nodes from the right neck were positive for metastatic carcinoma.
The patient initiated an arbitration against Dr. OTO alleging she was misinformed about her biopsy result and that the nearly five-month delay in her diagnosis caused her to undergo a more extensive surgery and decreased her chance of surviving. The patient and Dr. OTO resolved the dispute prior to arbitration.
Personal calls by physicians to patients on initial labs can give patients the benefit of a physician’s own thinking on what should happen next. Also, the act of sitting down with a report, rephrasing it into plain English, and preparing for a patient’s questions can serve as a kind of “time out” for the physician — providing one more opportunity to make sure everything is in order.
Author Gordon Ownby is General Counsel for the Cooperative of American Physicians, Inc.(CAP).
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.