Will Patient Sue Due to Abnormal Finding, or Not?
It might depend on how you tell them
Whether a patient sues after learning an initially normal finding was re-read as abnormal has something to do with how the emergency physician (EP) approaches the situation.
“If you approach it defensively, sounding worried about a ‘mistake,’ it may inflame an already sensitive communication,” says Randy Pilgrim, MD, FACEP, CEO and chief medical officer of Schumacher Group in Lafayette, LA. “You can’t always help whether patients will hear, ‘They read it wrong,’ or ‘They screwed up.’ But almost everyone loves it when they can tell you are really working diligently on their behalf.”
When conveying an abnormal finding to a discharged ED patient, Pilgrim says, “One of my commitments is to provide you with the best care with the best information I have. The good news is that many eyes have looked at your results, and we believe there is something new I should tell you about. I’d like to update our recommendations for your care.”
Pilgrim next tells the patient what was found, what it means, and what to do now. He then explains what is different from the prior plan for treatment and follow up.
Michelle M. Garzon, JD, an attorney with Williams Kastner in Tacoma, WA, advises EPs to tell patients, “As I told you, I did a preliminary read of your X-ray. Our procedure is that the radiologist reads it next day. Fortunately, the radiologist was able to identify a really subtle finding.”
Garzon says the EP should convey the message, “This is a process that worked.”
How Much to Explain?
Most ED patients have no idea that a cardiologist will over-read their EKG, or a radiologist will over-read their X-ray, says Angela Gardner, MD, FACEP, an assistant professor in the Division of Emergency Medicine at the University of Texas Southwestern Medical Center in Dallas. For this reason, patients may be surprised and upset to learn that their result wasn’t normal after all. When Gardner has been uncertain about findings, she’s told the patient so, by saying, “I’m not sure if your ankle is fractured or not. Either way, you will need a splint for a few days. Someone will read it tomorrow.”
ED discharge instructions should state that all readings are preliminary, “so patients have some idea that there may be a phone call coming,” says Gardner. “But this is a delicate area.”
Gardner says it’s not advisable for EPs to tell a patient they are discharging, for example, “You might have an aortic dissection, but I don’t think so.” “If that turns out to be the case, then the EP will be asked, ‘If you were worried about this, then why did you let the patient go home?’” she says.
Since patients sometimes give inaccurate contact information because they’re fearful of getting a bill, Gardner asks her patients, “Would you please give me your cell phone number so that I may call you if this test is positive? I will be placing this in the medical record for the purpose of contacting you about this test.”
“I have never had a patient refuse to give me their cell phone number when I word it that way. It always surprises me how often it’s different from what we have in the chart,” she says.
Second Encounter
A plaintiff attorney will explore whether the EP’s medical decision-making and subsequent recommendations were reasonable after the abnormal result was identified, notes Pilgrim. “In many ways, you have to think of this as a second patient encounter,” he says. “Did you do what was reasonable, even though the patient may not be sitting in front of you?”
There is a tendency for EPs to treat the discharged patient on the phone “a little less intensively” than they would if the patient was in the ED, says Pilgrim. For this reason, he says, “it’s often a great idea to have them come back, make sure they understand what they are to do, and document accordingly.”
Whether a patient sues after learning an initially normal finding was re-read as abnormal has something to do with how the emergency physician (EP) approaches the situation.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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