Dr. M, 55, was a family practitioner with his own solo practice. The physician had owned his practice for the previous decade and business was quite good. It was so good, in fact, that Dr. M had to restrict how many new patients he could take. Many of his patients had been with him since he began his practice, and his time was getting tight. Rather than take on partners, or hire a nurse practitioner to ease the load, Dr. M chose to limit his work load by taking fewer new patients.

One new patient that Dr. M did take on was Ms. C. When going over her previous medical history at her first appointment, the 30-year old female patient told the physician that she’d had a splenectomy at the age of 10 as a result of mononucleosis. She also recalled getting a pneumococcal vaccine following the splenectomy. Dr. M noted this in his records, as well as the fact that Ms. C reported having a history of seasonal allergies. The physician prescribed loratadine and fluticasone propionate nasal spray for the allergies, and scheduled Ms. C for a follow up in two months.

At the patient’s next appointment, Dr. M discussed the need for a tetanus booster, and noted this in Ms. C’s file, but did not discuss any other immunizations or other issues. Over the following 13 months, Ms. C came in sporadically – once for a work-related physical exam, and a few times for minor health problems – but nothing out of the ordinary. Other than the very first appointment when Ms. C informed the physician that she was asplenic, and he noted it in the file, the two never discussed the patient’s lack of a spleen again, and the physician assumed that Ms. C understood the potential medical ramifications of having no spleen. 

Eight months after Ms. C’s last visit to the doctor she became quite ill and developed a 105 degree fever and a nosebleed lasting 30 minutes. Ms. C called Dr. M’s office, but because it was evening and after office hours Ms. C’s call was transferred to a local trauma center nurse. The nurse, who had no access to the patient’s records, listened to Ms. C’s descriptions of her symptoms and surmised that Ms. C had the flu. The nurse recommended ibuprofen and told Ms. C that the center would reopen at noon the next day if she wanted to come in. However the next morning Ms. C’s condition had worsened and her husband took her to the local emergency department. After blood work revealed that Ms. C’s blood was positive for streptococcus pneumonia, she was diagnosed with pneumococcal sepsis and immediately started on antibiotics. Unfortunately, during her recovery, Ms. C developed compartment syndrome in both legs, which led to amputation of both feet. Ms. C left the hospital permanently wheelchair bound, and requiring treatment for recurrent osteomyelitis. The experience left Ms. C suffering from anxiety and depression.