An Internist's Perspective on Medical Malpractice

TASA ID: 3656

Medical malpractice typically arises when there are concerns that a reasonably prudent physician with similar training would have achieved a more favorable outcome than what actually occurred.  In other words, standard of care gets violated.

As an internal medicine expert in active private practice for the past 29 years, there is no question that my experience has enabled me to more quickly recognize patterns of illness and red flag symptoms, which require additional diligence.  Over the past 10-15 years, my regular work as a medical expert, particularly in medical malpractice cases, has improved my skills as an internist.  Learning from mistakes creates lasting lessons.

Most cases I have seen relate to diagnostic errors which arise because the doctors failed to register or measure key information, like vital signs.  Simple vital signs are often the first clue to many serious illnesses, including early sepsis, pneumonia, pulmonary emboli, pancreatitis, and even GI bleeding. 

For example, the patient with a cough and shortness of breath or a rapid pulse, probably doesn’t have a cold or viral illness, even though colds and viral illness are very common.  Having a smoking history and a cough, particularly one that worsens over time, should prompt a physician to order an imaging study to rule out lung cancer, rather than just assume it is due to heartburn or reflux disease. 

In order to perform like a reasonably prudent physician, a certain amount of time and thought is required.  Quick decisions, under pressure can limit the options available.  Getting a sufficient history from the patient and doing a sufficient exam may not be necessary for benign symptoms, but those same omissions can lead to a malpractice case, if the patient with real illness happens to arrive.

A common mistake is the belief or myth that doing a neurologic exam is time consuming.  It is not, and since it is part of the physical exam, it also counts as standard of care.  A primary care physician needs to know the subtle signs of stroke, as well as acute confusional state, which can be due to drugs, alcohol, infection, intracranial bleeds from trauma, as well as strokes.  It is not uncommon to see the mistake where the doctor seeing an acutely confused patient assumes they suffer from chronic dementia, like Alzheimer’s disease.  Unfortunately, that mistake often leads to bad outcomes.

There are several reasons to believe that the number of medical malpractice cases will increase in the future.  First, there is the mandate that all physicians must utilize electronic medical records. This mandate requires doctors to demonstrate meaningful use which includes the need to provide medical records to patients, along with establishing an actual portal for patients to peruse their own records.  Current studies seem to indicate frequent discrepancies observed between those records and patients’ actual medical data.

Ironically, electronic medical records often lead to worse physician-to-physician communication. In private practice, although doctors use electronic records, they are often set up through different vendors, which currently lack the ability to interact with each other.  As internists, we rarely get letters from specialists we refer to, especially if we use hospital-based physicians; instead they just type their consult into the hospital electronic records and assume that other doctors will access those records if needed. Unfortunately, there is no notification that such a consult actually took place.

Certainly, another reason involves the increasing volume of patients that many doctors are seeing these days, which can limit their face-to-face time with during office visits.  This seems to reflect government policies which equate insurance coverage with actual healthcare, instead of recognition of the value of a quality doctor/patient relationship.  Doctors feel strained, especially those working on quotas to see a certain number of patients per day.  Also, there are more nurse practitioners and physician assistants doing the work of doctors these days.

Finally, I would point out that it’s often important to use an internist early, in order to decide which medical experts are most needed.  I have been involved in some cases where several subspecialists were already used, only later to realize that the most important part of the case doesn’t really depend on their testimony, but rather on the basic standard of care issues for the primary care doctor.

This article discusses issues of general interest and does not give any specific legal or business advice pertaining to any specific circumstances.  Before acting upon any of its information, you should obtain appropriate advice from a lawyer or other qualified professional.