This month we look at the issue of whether a physician can be liable for relying on information provided by the patient. As a clinician, it is unwise to simply rely on a patient’s self-diagnosis without coming to an independent conclusion. But what if relying on a patient’s report is necessary for providing treatment?
Dr L, 48, was a physician working in a walk-in medical clinic in a busy metropolitan area. His days at the clinic were pretty much non-stop, without much downtime, but he liked it that way. He enjoyed the variety of patients that presented at the clinic. While the work was exhausting, he found it challenging and interesting as well, and he was glad to work in an environment where he saw a diversity of diseases and injuries.
One day, a patient presented in the clinic with a chemical burn to his finger. The patient, Mr M, was a 32-year-old white male who worked in the industrial plant located a few blocks away. The clinic’s nurse did a preliminary work up and then alerted the physician. Dr L grabbed the patient’s file on the way into the exam room and did a quick scan of the nurse’s notes. The patient had told the nurse that he had been burned with muriatic acid while working at the nearby factory. Dr L knew that muriatic acid was another name for hydrochloric acid, and that the industrial grade of hydrochloric acid is typically called muriatic acid.
Dr L walked into the exam room and introduced himself to Mr M. “I hear you have a chemical burn on your finger,” the physician said to the patient.
“Yes,” said Mr M, holding out his hand so the physician could examine the burn.
Although Dr L had the nurse’s note, he asked the same question that the nurse had. “Do you know what you were burned with?”
“Yes,” said Mr M. “It was muriatic acid. I was moving a container of it and it wasn’t sealed properly. Some splashed out onto my finger.”
Dr L chatted with the patient about the importance of work safety as he made a note in the patient’s file about the nature of the burn. He then treated the burn, wished the patient well, and sent him off.
The next day, Mr M went back to his work and discovered that his burn had not been caused by muriatic acid, but by hydrofluoric acid instead. The patient went to the closest hospital emergency room for treatment. Unfortunately, treatment was unsuccessful, and ultimately the patient’s finger was amputated mid-knuckle, making it difficult for him to work. The remaining part of the finger became very sensitive to heat and cold, and Mr M became increasingly angry and bitter.
On the advice of a friend he sought the counsel of a plaintiff’s attorney. “If I had been treated properly by the first doctor I would never have lost my finger,” he told the attorney. The attorney took the case, and filed a lawsuit against Dr L.
Dr L was shocked when he received notification that he was being sued. He met with the defense attorney provided by his insurance and explained the situation. “The patient told me he was burned with acid, and he told me what acid, specifically, he was burned with,” said the physician. “Is it my fault that he was wrong?” The attorney agreed that he did not believe that Dr L did anything wrong, but he warned him that juries are notoriously unpredictable and that going to trial was always something of a risk.
“I don’t care,” said Dr L. “I will take the risk – I did not do anything wrong.”
After months of discovery and paperwork, the case finally went to trial.
At trial, the plaintiff’s attorney argued that Dr L was negligent in his treatment of Mr M. Just as a doctor wouldn’t rely on a patient’s self-diagnosis when determining a treatment, a doctor should also not rely on a patient’s own determination of what type of acid he was burned with, argued the attorney.
The patient testified that he hadn’t given the physician enough information to allow Dr L to rely on the fact that the burn was, actually, caused by muriatic acid. He testified that his wife, who formerly stayed at home with their toddler, now had to work because he could no longer support his family.
The defense argued that there was no reason for Dr L to think that Mr M was not a credible individual, that the patient had told both Dr L and the nurse that he had been burned with muriatic acid and that there was no reason to believe otherwise. Medical expert testimony supported the fact that Dr L provided the appropriate treatment for a muriatic acid burn.
The jury returned after a brief time in deliberation with a verdict for the defense. Dr L was exonerated.
Although Dr L did not provide the right treatment for the patient’s burn, he did do the right thing in this case. He did not just rely on the patient’s statement to the nurse about the cause of the burn, he asked the patient himself and got independent verification. There was no reason why Dr L should not have believed the patient’s recounting of what type of acid had burned him – the patient worked in the industrial field.
This is a very different situation from one in which a patient comes in saying only “I have an acid burn,” and not identifying it. If the patient doesn’t or can’t identify the source of the burn, the clinician would be obliged to determine what type of burn it was in order to provide the appropriate treatment.
However, in a case such as this where a patient is injured at work by a substance that he works with and identifies, it is reasonable for the clinician to rely on the patient’s assertion. To fully protect yourself, be sure to ask questions about how the incident occurred, ask the patient if they are certain about the substance, and take good notes that document this. While you can’t always protect yourself from being sued, you can protect yourself from being found liable.