Patient Permanently Injured When Clinician Fails to Ask About Rx History

Taking time to ask one simple question could have avoided the bad outcome for both patient and clinician
Taking time to ask one simple question could have avoided the bad outcome for both patient and clinician

This month's case looks at the important issue of communication, and how good communication and asking the right questions can help protect you from errors and lawsuits. Primary care practitioners are busier than ever these days, and it is easy to have one's attention divided. This case looks at the danger of not giving your patient 100% attention, and how taking the time to ask one simple question could have avoided the bad outcome for both the patient and the clinician.

Dr. V, 61, was a family practitioner who had a small practice with three other physicians. He had been with the practice for over two decades, and had every intention of remaining there until his retirement. The physician had a loyal following of patients in his town. Because he had been practicing in the same place for so long, he was now even seeing the grown children of patients in some cases as well.

In recent years, he and his partners had been forced to see more patients in shorter periods of time. This sometimes led to a crowded waiting room and impatience.

Late one afternoon as Dr. V was getting ready to enter the exam room to see his last patient of the day, the office's receptionist stopped him in the hallway to say that Ms. B was calling on behalf of her mother, Mrs. B. Both the mother and daughter were patients of Dr. V, but he saw the 52-year old mother far more often than her 30-year old daughter. The mother, Mrs. B, suffered from migraines. Over the past several years she had been prescribed various medications for migraine by Dr. V, most recently almotriptan, with mixed success.

The physician looked at the exam room door, knowing that a patient was waiting there. He looked at the receptionist with the phone in her hand.

“Did Ms. B say what the problem was?” he asked the receptionist.

“Yes, she said that her mother was having a migraine and was in a lot of pain and wanted to try something different and was hoping you could call in a prescription,” she replied.

Glancing once more at the door behind which his next patient was waiting, he reached for the phone. “I'll speak to her,” he told the receptionist.

On the phone, Ms. B reiterated what she had told the receptionist. Her mother was suffering from a migraine, was in a lot of pain, was sensitive to light and sound and was queasy. She wanted to try a new treatment option.

“Okay,” said Dr. V, still eyeing the exam room door. “I will call the prescription in to your mother's pharmacy. Will you be able to pick it up for her?”

The daughter agreed that she would pick up the medication.

“Please have your mother call us tomorrow,” said Dr. V, “to schedule an appointment to discuss more strategies for treating the migraines.”

The physician quickly called the pharmacy and ordered sumatriptan for Mrs. B. He noted the new medication in her file, and finally went into the exam room to see the last patient of the day.

The next day he didn't hear from Mrs. B, but assumed she would call to make an appointment when she was feeling better. Unbeknownst to Dr. V, Mrs. B suffered a hemorrhagic stroke after taking the new medication prescribed by him.