A defensive echocardiogram would have spared this doctor a lawsuit:
Attorneys on both sides seemed to agree that the case largely hinges on whether Razzak should have ordered an echocardiogram, a test that uses sound waves to create a moving picture of the heart.“When you don’t order the echocardiogram, that falls below the standard of care,” said Brad Rhor, one of two attorneys representing Orr.
Defense attorney Robert Watson Jr. reminded jurors that he had offered testimony from several physicians who said they wouldn’t have ordered an the echocardiogram based on the symptoms Orr presented. A diagnosis of atrial myxoma – the heart tumor which led to Orr’s stroke – is one in a million, he said.
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I can’t think of a single reason why you would order an echocardiogram on a patient who presented with a single seizure. A head CT or MRI and EEG, maybe, but certainly not an echo.
Had the patient originally presented with a stroke, then I would agree that an echo was the standard of care.
Errors of ommision almost NEVER make any sense in a lawsuit. I order a CT Scan, I should have ordered an Ultrasound. I ordered an EKG, I should have ordered a D-Dimer. You do your best, order 10 tests, but miss one. AQnd then some retiree who used to practice cardiology stands up in court and says “ordering an Echo on this healthy 35 year old is the ’standard of care’” “I would routinely do an echo on any patient like this who walked into my (cardiology) practice.” And they wonder why we order defensive tests? And why there is such an antagonistic relationship between patients and doctors?
A nondoctor asks: if possible transient ischemic attack during a Valsalva maneuver + youngish patient + atrial enlargement isn’t suspicious enough to warrant an echocardiogram, what is?
” if possible transient ischemic attack during a Valsalva maneuver + youngish patient + atrial enlargement isn’t suspicious enough to warrant an echocardiogram, what is?”
How about Syncope with a family history of early cardiac death. Would you like another 100 more likely scenarios.
As an ER DOc, for me the teaching lesson here is it sounds (though, no CJD, I don’t have the records) like some lucky ER doc inappropriately admitted a first time seizure. The so-called “standard of care” for first time seizures is discharge and outpatient workup (after a CT Head.) But this ER doc admitted the pt., passing the legal responsibility off to an internist. If you’re an ER doc, the more you admit to your poor internal medicine colleagues, the better. It lessens your risk, and passes it along to them. Let some other poor schmuck take the fall. It’s a dog eat dog world out there. My admission rate just went even higher!! (And the healthcare system more bankrupt!)
And what does the IM doc do? EEG and a neurology c/s, hence spreading the feces even wider.
“And what does the IM doc do? EEG and a neurology c/s, hence spreading the feces even wider.”
Neurologist gets an MRI, thus bringing in the radiologist (and another $2000 of taxpayer $$$) to the CYA Gangbang.
Don’t forget a vascular surgery consult if there is significant carotid plaque on the MRA
Vascular surgeon refers the patient to a Cardiologist for “medical clearance for surgery”Cardiologist orders echo, dobutamine study, if he finds anything maybe he refers to an invasive cardiologist for a catheterization. Add another $20,000, all this to avoid the lawyer sharks..
And if the jury finds in the doctor’s favor?
The doctor never “wins” He either loses the case outright, in which case his reputation is tarnished, has trouble getting insurance, career can be ruined, or the jury “finds in his favor”, which means the trial took alot of his time, money and affected his health. No such thing as a “victory” OK here comes some vermin sodomite with the “how about the patient’s loss” comment. Save it for Oprah.
He’s right, of course. Physicians are the only thing that matters in this. Especially physicians like him.
Buy a Powerball ticket sodomite. Just as likely you’ll win and less damage to what’s left of the fragile healthcare system.
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