Doctors, Are You Listening to Your Patients? Communication From the Patient’s Perspective Part 2

physician communication, patient respect, patient advocacy, medical errorsHere’s what doctors need to know – from your perspective, as a patient. Imagine what your health care would be like if all doctors read this article.

3. Tell me about the risks/options. Ask me to bring a family member or friend to my appointments to listen to your explanations so I can get a fuller picture. Involve me in the decision making.

The plaintiff, age forty-six at the time, underwent a hysterectomy in June 2005 after large uterine fibroids were discovered. The surgery was performed by obstetrician/gynecologist Orlito A. Trias. The plaintiff opted not to have her ovaries removed at that time. In August 2006 the plaintiff was diagnosed with ovarian cancer and had the ovaries removed. The cancer had spread to her pelvic cavity, bowel and lymph nodes. The plaintiff had two recurrences, one of which was found during the trial. The plaintiff had a family history of breast cancer, with her mother dying at age forty-eight, a cousin at age twenty nine and her grandmother at age fifty-two. Several aunts also had breast cancer. The plaintiff claimed that this family history placed her at an increased risk for ovarian cancer. The plaintiff claimed that Dr. Trias failed to inform her that she was at an increased risk for ovarian cancer and that he should have recommended removal of the ovaries. The plaintiff claimed that she would have consented to the ovary removal informed of the cancer risk, just as she had undergone prophylactic bilateral mastectomies at the age of twenty-two due to the family history of breast cancer. Dr. Trias admitted that he did not tell the plaintiff of an increased risk of ovarian cancer or that ovarian cancer is undetectable in its early stages. Dr. Trias claimed that he had instructed the plaintiff to obtain pre-genetic testing to see if she had a gene mutation which indicates an increased risk of ovarian and breast cancer. According to a published account a $4 million verdict was returned for the plaintiff and her husband was awarded $1 million for loss of consortium. Post trial motions were expected. Allison and Michael Downs v. Orlito A. Trias, M.D., et al., New Milford (CT) Superior Court

4. Tell me about abnormal lab results. Make sure I know about them and what I am expected to do to have them investigated.

The plaintiff’s decedent, age seventy four, was admitted to the hospital for a fractured a left ankle after a fall on ice in late January 2005. She underwent open reduction with internal fixation to repair the fracture. A preoperative chest x-ray was performed and a two centimeter nodular opacity was noted in the right upper hemithorax. Radiology recommended a CT scan to rule out cancer. The treating internists, David Collon and Josh Meier, did not order the scan or refer the decedent for a biopsy. A second x-ray taken two days later again showed the nodule, but the decedent was not told of the abnormality. The attending internist at the time, Eric Scher, also did not order follow-up testing or refer the decedent to a specialist. The decedent continued treatment with the physicians with no referrals or further testing regarding the nodule. In late 2007, the decedent was admitted to the hospital with shortness of breath and sweating. A chest-x-ray revealed pneumonia and the previously identified mass. She was diagnosed with non-small cell lung cancer. The cancer had metastasized and was inoperable. After extensive chemotherapy and radiation, the decedent died of the cancer. The plaintiff alleged negligence in the failure to timely diagnose and treat the lung cancer. According to the Michigan Trial Reporter a $325,000 settlement was reached. Paul Harris, PR of the Estate of Rosa Green, deceased v. David Collon, MD, Josh Meier MD et al, Wayne County (MI) Circuit Court, Case No. 08-01472-NH.

Patricia Iyer MSN RN LNCC teaches nationally to nurses, physicians, attorneys and paralegals about how to reduce liability. She is president of Avoid Medical Errors, and runs her business in Flemington, NJ.

Barbara Levin BSN, RN, ONC, LNCC is the Clinical Scholar of Orthopaedics Trauma at Massachusetts General Hospital. While providing direct patient care, she educates patients and their families about a variety of health issues. Nationally, she teaches nurses, physicians, occupational therapists and physical therapists about documentation in clinical practice.

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