Resources
Case Studies - Read & Test
previous
Cooperation Between Providers
ISSUE: What is the duty of a physician to attend to the concerns raised by other providers?
An internist diagnosed and began treating a 46-year-old woman for Polycythemia Vera. The internist prescribed a therapeutic phlebotomy. He ordered the procedure and sent her to the blood bank at the medical center where he was employed. When the procedure was completed, an elastic bandage was placed over the venipuncture site. A short time later, the patient experienced pain and swelling under the bandage. She notified the phlebotomy nurse who removed the bandage, examined the swelling, and noted that the area of swelling was larger than she had seen in her five years of experience. She called the internist who briefly looked at the patient's arm, told her that "the whole thing is going to turn black," and walked out of the room. The nurse subsequently gave the patient a prescription for pain medication and escorted her out of the center shortly after 5 p.m.
The patient's arm continued to swell and became increasingly painful throughout the night. The next morning, the patient's son drove her to the emergency department where she was diagnosed as having an arterial laceration and a compartment syndrome. The compartment syndrome had progressed to the point that the patient required a fasciotomy to relieve the pressure in her arm. The incision required 47 staples to close. She remained at the hospital for six days before moving to a rehabilitation center where she remained for a month, attempting to regain some of the functioning in her right hand.
The patient sued, alleging that the internist should have either: (1) kept her at the clinic for observation, (2) placed her in a hospital for observation, (3) ordered a duplex scan of her arm, or (4) provided her with sufficient post-procedure instructions. She claimed that had any of these steps been taken, she could have alerted medical personnel to her condition before it progressed. The physician argued that bleeding and a hematoma at a venipuncture site were so common that further examination was unnecessary, even after the nurse's report.
An internist diagnosed and began treating a 46-year-old woman for Polycythemia Vera. The internist prescribed a therapeutic phlebotomy. He ordered the procedure and sent her to the blood bank at the medical center where he was employed. When the procedure was completed, an elastic bandage was placed over the venipuncture site. A short time later, the patient experienced pain and swelling under the bandage. She notified the phlebotomy nurse who removed the bandage, examined the swelling, and noted that the area of swelling was larger than she had seen in her five years of experience. She called the internist who briefly looked at the patient's arm, told her that "the whole thing is going to turn black," and walked out of the room. The nurse subsequently gave the patient a prescription for pain medication and escorted her out of the center shortly after 5 p.m.
The patient's arm continued to swell and became increasingly painful throughout the night. The next morning, the patient's son drove her to the emergency department where she was diagnosed as having an arterial laceration and a compartment syndrome. The compartment syndrome had progressed to the point that the patient required a fasciotomy to relieve the pressure in her arm. The incision required 47 staples to close. She remained at the hospital for six days before moving to a rehabilitation center where she remained for a month, attempting to regain some of the functioning in her right hand.
The patient sued, alleging that the internist should have either: (1) kept her at the clinic for observation, (2) placed her in a hospital for observation, (3) ordered a duplex scan of her arm, or (4) provided her with sufficient post-procedure instructions. She claimed that had any of these steps been taken, she could have alerted medical personnel to her condition before it progressed. The physician argued that bleeding and a hematoma at a venipuncture site were so common that further examination was unnecessary, even after the nurse's report.
From your analysis of the case, assess whether the following statesments are true or false:
| * | A physician's bedside manner makes little to no difference in a patient's decision to take legal action for an injury the patient considers to be the result of substandard care. | True or False |
| * | Concerns expressed by trained healthcare professionals regarding post-procedure symptoms deserve careful attention by a physician. | True or False |
| * | A dismissive attitude toward other staff members by a physician may be considered disruptive behavior that increases the risk of patient injury. | True or False |
Expand to check answers
GENERAL PRINCIPLE: While not every post–procedure complaint indicates a serious complication, when a trained professional indicates that there may be a problem, the supervising physician has a duty to respond appropriately.
APPLIED PRINCIPLE: The patient underwent a fairly routine procedure–the removal of venous blood–performed at a blood bank by an experienced nurse. Serious complications that arise from this procedure are rare. Certainly, a small hematoma at the venipuncture site would not be unexpected or cause for serious concern. Under normal circumstances, the nurse could have advised the patient when she complained of swelling. However, in this case, the nurse felt that the swelling was greater than she had seen in years of experience. Therefore, the physician was obligated to carefully examine the patient and consider a potential arterial injury or an undetected bleeding disorder that may have required attention and possible intervention.
The physician's response was not only substandard care, but his lack of attention and dismissive attitude toward the patient and the nurse could be viewed as disruptive behavior that did not foster patient safety. The patient would certainly take into consideration the physician's lack of compassion in her decision to proceed with a lawsuit. While good "bedside manner" will not prevent every lawsuit, it is often a factor in the patient's decision to take legal action against a healthcare provider.
previous
APPLIED PRINCIPLE: The patient underwent a fairly routine procedure–the removal of venous blood–performed at a blood bank by an experienced nurse. Serious complications that arise from this procedure are rare. Certainly, a small hematoma at the venipuncture site would not be unexpected or cause for serious concern. Under normal circumstances, the nurse could have advised the patient when she complained of swelling. However, in this case, the nurse felt that the swelling was greater than she had seen in years of experience. Therefore, the physician was obligated to carefully examine the patient and consider a potential arterial injury or an undetected bleeding disorder that may have required attention and possible intervention.
The physician's response was not only substandard care, but his lack of attention and dismissive attitude toward the patient and the nurse could be viewed as disruptive behavior that did not foster patient safety. The patient would certainly take into consideration the physician's lack of compassion in her decision to proceed with a lawsuit. While good "bedside manner" will not prevent every lawsuit, it is often a factor in the patient's decision to take legal action against a healthcare provider.
| * | A physician's bedside manner makes little to no difference in a patient's decision to take legal action for an injury the patient considers to be the result of substandard care. | False |
| * | Concerns expressed by trained healthcare professionals regarding post–procedure symptoms deserve careful attention by a physician. | True |
| * | A dismissive attitude toward other staff members by a physician may be considered disruptive behavior that increases the risk of patient injury. | True |