Dorothy’s therapist reported a slow but gradual improvement in her pain. Great news. I thought I was in the clear. Then one day, Dorothy reappeared at my office, accompanied by David, complaining of back pain. My unease turned to alarm when they explained how they wanted me to be in charge now, instead of “that terrible Dr. R.” Over the next several weeks, I tried my best to refer them to a new primary care doctor. I contacted several internists who practiced in her area, but Dorothy resisted. She assured me that she would transfer her care to one of them after I took care of her back pain. The weeks turned to months. Her back pain was not improving with therapy. There were a few more office visits, each one replete with a hostile denunciation of Dr. R.
The situation reached a climax one Sunday morning, when Dorothy experienced an episode of severe lightheadedness. Instead of seeking urgent care at their fine community hospital, David bravely drove his wife through a drenching autumn nor’easter to get to our hospital’s emergency department. To my consternation, the medical team notified me that I was listed as her attending physician. At the time of her discharge, she finally agreed to continue her care with a new internist working at our sister institution, the Massachusetts General Hospital in Boston. Her file could finally be closed.
Several months later, Dorothy’s new doctor called to update me on her condition. She had obtained Dr. R.’s old records and learned that two years earlier, at Dorothy’s last visit with him, three stool samples were analyzed for the presence of occult blood. His medical assistant listed all three samples as showing trace amounts of blood, but Dr. R. never told Dorothy about these results, nor did he recommend any follow-up studies, such as a colonoscopy. Instead, her new physician ordered this procedure, but it was too late. A stage IV adenocarcinoma of the bowel was found. Despite aggressive surgery and chemotherapy, Dorothy died one year later. Not surprisingly, her estate was suing Dr. R. for failing to make a timely diagnosis of a potentially treatable cancer.
Defensive Medicine
Another cream-colored envelope arrived at my office a few weeks after the first. I was going to be deposed in this malpractice lawsuit. Dorothy’s attorneys wanted to hear more about her back pain. Why was she in so much pain for so many months? Had I considered the possibility that her pain could have been due to metastatic cancer and not to lumbar spine disk disease? Shouldn’t I have intervened sooner?
