The case went to trial. At trial, Mr. P described his encounter with the patient, and testified that neither Mr. C nor Mrs. C mentioned symptoms other than pain, such as shortness of breath or lack of appetite. He noted that he did not observe sweating or pallor during his examination of Mr. C. He further testified that he had told Dr. L that Mr. C reported the pain as increasing over the past few days.

When Dr. L testified, she said that Mr. P never told her about the patient’s increasing pain, and that had she known about that she would have examined Mr. C herself and would have noticed the signs of infection and ordered a CT scan or MRI.

The patient’s widow testified that she had described all of her husband’s symptoms to Mr. P. She heart-wrenchingly described how she had repeatedly asked for an MRI for Mr. C and had been told that it was not necessary.

During closing arguments, the attorneys for the clinicians highlighted how rare and unusual a psoas infection was, and how unlikely it was that the clinicians had ever seen a case of it. Nevertheless, the judge ruled in favor of Mr. C’s family and awarded $7 million in damages.

Protecting Yourself

Psoas infections are indeed rare, but not unheard of, and both clinicians testified that they were familiar with the condition. It is not clear how much information Mr. P had, but he certainly knew that the patient’s pain had been increasing and not decreasing. He should have known that increasing pain is not consistent with muscle strain. While muscle strain was an easy diagnosis to arrive at in this case, the fact that pain was increasing should have been a tip off that the diagnosis might not be that easy and that further questioning of the patient should take place.

It’s unclear whether Mr. P shared the information about the increasing pain with Dr. L. If he did, then Dr. L was negligent in not questioning the diagnosis. If he didn’t, then Mr. P was negligent in not conveying the relevant facts. Either way, more questions should have been asked of the patient before arriving at the diagnosis of muscle strain.

Just because a diagnosis is the easiest or the most common doesn’t mean it’s necessarily the right one.