Doctors, Are You Listening to Your Patients? Communication From the Patient’s Perspective Part 3

patient education, patient advocacy, physician communicationHere’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.

5. Give me education. Providing education at appointments and discharge from a healthcare facility will allow me to be aware of acute events which need intervention. Make sure you give me prescriptions for new drugs and clear instructions on what I need to contact you about after discharge. Tell me when and why I need to return to your office. Make sure there is a system in place in your office to keep track of me if I don’t come back.

The plaintiff’s decedent, age twenty-six, went to a dermatologist with a mole on his upper back. A complete excision was performed. The tissue was reviewed by a pathologist, who suggested that the decedent return for follow-up. The decedent returned to the dermatologist twice over the next six months, but proper follow-up did not occur. The plaintiff claimed that the office had no system in place to contact him when he failed to return. Two years later the decedent noticed an area on his back near the scar from the previous excision. A biopsy performed at a hospital led to a diagnosis of metastatic melanoma. The slides from the original biopsy and excision were obtained and reviewed, with a finding of “melanoma, superficial spreading type, invasive to a depth of a minimum of 1.0 mm anatomic Level IV; extending to inked deep resection margin.” The decedent underwent a wide local excision and was diagnosed with Stage III melanoma. He underwent neck and back radiation treatments and high-dose alpha Interferon treatments, followed by high-dose Interleukin-II and chemotherapy. Treatment was unsuccessful and the man died. The plaintiff claimed that the chances for cure would have been between seventy-three percent and ninety-four percent if diagnosed at the time of the initial excision. According to a published account a $1.75 million settlement was reached. Estate of Anonymous Twenty-Six Year-Old Man v. Anonymous Dermatologist and Anonymous Pathologist, unknown Massachusetts venue.

6. Advise me about necessary screening and prevention methods. Make me a partner in monitoring my health.

The plaintiff began seeing the defendant physician in October 1997 because her family practice physician was leaving the practice. The plaintiff was seen almost exclusively by Dr. Elsen from then until May 2004. Dr. Elsen never discussed colon cancer screening with the plaintiff and never recommended colon cancer screening during that time. In May 2004 the plaintiff, age sixty-six, was diagnosed with Stage lIB adenocarcinoma of the colon. She underwent removal of part of the large intestine and six months of chemotherapy. The plaintiff alleged negligence in the failure to recommend colon cancer screening. The plaintiff claimed that she would not have developed cancer if screening had occurred. Dr. Elsen claimed that recommendation of screening was not required because the plaintiff used his office only for acute care issues. According to Cook County Jury Verdict Reporter a $357,130 verdict was returned. Julie Davis v. Evergreen Medical, Ltd., Dr. John Elsen, Cook County (IL) Circuit Court, Case No. 05L-4939.

Patricia Iyer MSN RN LNCC teaches nationally to nurses, physicians, attorneys and paralegals about how to reduce liability. She is Avoid Medical Errors’ president, 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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