When “Difficult Patients” Attack

February 4, 2010 in Medical Legal by RangelMD

In medical industry parlance, they are known as the “difficult patient”. In every-day parlance, these patients are known as a**holes or referred to by other colorful idioms. They are the people who have very poor ways of dealing with external stressors and who seem to have been put on this Earth to make sure that nobody else gets too happy in life.

Dr. N, a 58-year-old cardiologist, had one such patient, an insulin-dependent diabetic who was found to have severe cardiovascular disease after developing chest pain and undergoing a cardiac catheterization. Like many difficult patients, this diabetic sought out medical assistance and consultation from Dr. N. and then paradoxically, repeatedly refused to follow his medical recommendations. After finally undergoing coronary artery bypass surgery, the patient developed a serious sternal wound infection and refused to return to the hospital for intravenous antibiotics, instead demanding that Dr. N. bow to her convenience and treat her over the phone by calling in a prescription for oral antibiotics.

Four days later, Mrs. Y called Dr. N, vociferously complaining that she had developed a fever. Dr. N obtained the culture report, and informed Mrs. Y that she would need to return to the medical center immediately, as tests indicated that she had multiple infections in her midsternal wound.

Mrs. Y refused. “I’m not coming back,” she announced. “It’s almost an hour away. I’m weak and it’s too far for me to go in my condition.”

“You have an infected wound,” Dr. N replied. “It needs to be examined and you will need antibiotics to treat it.”

“Why don’t you just prescribe the antibiotics over the phone” she asked.

“I’m sorry,” Dr. N said. “That’s not an option. You are best off returning here, so that I can properly evaluate the problem and start treatment right away. It’s dangerous for you to wait. This sort of infection can be life-threatening if not treated promptly.”

“Well, I’m not going,” Mrs. Y said. “You’ll just have to call antibiotics into my pharmacy.”

“Mrs. Y, this is very serious. I cannot prescribe anything over the phone without seeing you. You must get treatment. If you don’t want to come back here—which is really the best option—then your alternative is to go to your local emergency department immediately. You have an infection in your chest that must be treated or it could threaten your life. Do you understand?”

“I understand that you’re not being helpful,” replied Mrs. Y, hanging up the phone.

Dr. N noted the interaction in the file, sighed, and went on with his business.

Mrs. Y did not return to the medical center, and waited 10 days before going to the local emergency department. When Mrs. Y finally sought treatment, surgery was necessary to debride the wound, and a portion of her sternum was removed.

And true to the credo of the “difficult patient”: make everyone’s lives more miserable than your own, this patient reported Dr. N. to the state medical board and when the board dismissed the case for lack of wrong doing, the patient sued Dr. N.

The article author, Ann W. Latner, JD, uses this case to highlight the importance of having malpractice insurance. This case also highlights the absurdity of the current system in which a state medical board finds no evidence of wrong doing but an obviously frivolous lawsuit is allowed to wind it’s way through the system and consume valuable money and time.

In a better system, special malpractice courts made up of independent medical experts, legal experts, and consumer advocates (appointed by the court and not prostitutes hired by either side) would make a preliminary ruling on the validity of a suit and/or order each side to arbitration and require a large cash sum be placed in escrow if the defendant insists on proceeding with the case or with an appeal despite an unfavorable ruling from the court.

Even though the current system is designed to be mailable enough to allow cases with merit to see their day in court, it also is very susceptible to people who’s main motivation appears to be to use the system as a tool to harass and attempt to extort others as a way of fulfilling their credo in life.

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