A 33-year-old woman is transferred to the university medical center from a small community hospital due to acute pyelonephritis with sepsis. She has a history of recurrent urinary tract infections due to urinary retention related to a spinal cord injury in childhood. On arrival, the patient is febrile and lethargic. She provides no additional history, and the only information available is from poorly legible handwritten notes from the originating hospital. The patient is admitted to the intensive care unit with orders to give imipenem and vancomycin. Overnight, the patient develops a rash and severe respiratory distress requiring brief mechanical ventilation. The following morning, a transcribed physician note from the originating hospital arrives by fax and indicates that the patient has an allergy to multiple antibiotics, including imipenem. When discussing events with the patient and her family, which of the following statements is associated with reduced malpractice liability for the treating clinician?

Question

A 33-year-old woman is transferred to the university medical center from a small community hospital due to acute pyelonephritis with sepsis.  She has a history of recurrent urinary tract infections due to urinary retention related to a spinal cord injury in childhood.  On arrival, the patient is febrile and lethargic.  She provides no additional history, and the only information available is from poorly legible handwritten notes from the originating hospital.  The patient is admitted to the intensive care unit with orders to give imipenem and vancomycin.  Overnight, the patient develops a rash and severe respiratory distress requiring brief mechanical ventilation.  The following morning, a transcribed physician note from the originating hospital arrives by fax and indicates that the patient has an allergy to multiple antibiotics, including imipenem.  When discussing events with the patient and her family, which of the following statements is associated with reduced malpractice liability for the treating clinician?

Quizplus · Accepted Answer

11ec160b_3685_eab4_9249_df5c710f2208_MD0001_00 This patient experienced a severe medication allergy with respiratory distress. Although key information did not accompany the patient at the time of transfer, this event was likely preventable. In cases where important information is missing or incomplete, clinicians have a duty to obtain the information as soon as possible. Because of the harm done to the patient, this clinician is at risk for a medical malpractice claim. Most patients who experience complications, even avoidable complications, do not initiate a malpractice lawsuit. Patients who sue providers are typically not driven by financial rewards, but are more likely to be motivated by anger, distrust, or a feeling that the clinician is not concerned for their well-being. Often, patients report poor communication from the provider and file a lawsuit simply to get a better understanding of what happened. When speaking with a patient following a medical error, clinicians should directly and honestly discuss that an error occurred; concealing an error can appear dishonest and generate anger if the error is later discovered. The conversation should allow opportunity for the patient to ask questions, and answers should be given with language that the patient can understand. A plan to rectify the error should be provided. The provider should then convey concern for the patient and remain engaged with the patient's care until the issue has been resolved. (Choice A) Many experts recommend an apology be made to the patient following an error. However, specific blame (including self-blame) is not necessary and may make defending a claim more difficult later. (Choice C) This statement does not acknowledge that an error occurred and may be taken as blaming the patient. Plans for future prevention should generally come after an open discussion of the initial error. (Choice D) This statement conveys superficial concern but does not acknowledge the error and is likely to be seen as detached or blasé on the part of the clinician. (Choice E) Although factually correct, this statement conveys no empathy for the patient. It also deflects blame to the referring provider, which often generates distrust toward all of the involved parties. Educational objective: When speaking with a patient following a medical error, clinicians should directly discuss the error. The conversation should allow opportunity for the patient to ask questions. A plan to rectify the error should be provided. Finally, the provider should convey concern for the patient and remain engaged with the patient's care.

A 33-Year-Old Woman Is Transferred to the University Medical Center