This month’s case examines what could happen when a clinician diagnoses and prescribes based on complaints being relayed to her, without seeing, or even directly speaking to, the patient.

Dr. V was a family practitioner with a very busy small practice. The 55-year-old physician employed a receptionist to staff the front desk and answer the phones, and a medical assistant to prep patients and take vitals.    

One of the physician’s patients was Mrs. C, 69. The patient had been seeing Dr. V for the past four years for hypertension, asthma, osteoporosis, COPD, urinary tract infections, and allergic rhinitis. The patient, who was obese and had trouble getting around, came in with frequent complaints, most recently in early May for a sprained ankle.

On July 7th, as the physician was preparing to step into an exam room, her receptionist flagged her down.

“Mrs. C is on the phone,” said the receptionist. “She says that she’s experiencing a burning sensation upon urinating. Should she come in?”

The doctor glanced at her schedule. There was no time to squeeze Mrs. C in, and the physician knew that it was difficult for the patient to get to the office.

“Tell her that I’ll call in a prescription for Cipro to treat her UTI,” said Dr. V, and she directed the receptionist to note the call, the complaint, and the fact a 7-day course of antibiotics had been prescribed to treat the infection, in the patient’s record.

Two weeks later, on July 22, the receptionist caught the physician as she was between patients.

“Mrs. C called again while you were with a patient,” said the receptionist. “She said she has a bad cough and was coughing up mucus.”

The physician again looked at the schedule, sighed, and told the receptionist to call the patient back and advise her that the doctor would be calling in a prescription for a 10-day course of Ceftin, and Tussionex. The receptionist noted this in the file, and called the patient to advise her.

On July 28th, Mrs. C called the office again, this time complaining that she was not feeling better and that she had developed a slight fever. Again, the patient spoke only to the receptionist, who conveyed the message to the physician. This time the physician prescribed Tessalon Perles and recommended that the patient continue the antibiotics. (This information was again conveyed by the receptionist to the patient, and again the receptionist noted the content of the conversation with the patient, and the physician’s recommendations in the file.)