Another medical provider makes an egregious error/mistake...

[ShakaHoo]

Let's say it is not a life threatening mistake, but results in a permanent impairment of some sort...

 

Do you say anything to your patient? 

Do you say anything to the other medical provider? 

Would you go as far to report another medical provider?

 

Curious with how others deal with these situations.  

 

 

[Mayamom]

1.  Would never disclose this to the patient.  

2.  Depends.  Is it someone you work directly with or an outside provider and now your taking over their care?

3.  If it is an isolated incident no would not report this anybody except again if you work directly with the provider may discuss with your SP.  And any discussion with the provider itself should be a teaching moment; for everybody involved. 

 

[MediMike]

Is it your own group or organization? Your risk management department needs to be contacted NOW.

I would without a doubt bring it up to the provider and give them the opportunity to discuss the results of their medical error, if they refuse then you yourself have an ethical responsibility to disclose the mistake made to the patient.

I can't imagine any situation where a patient has suffered from a medical mistake and it is not disclosed to the patient and the provider is not held accountable. 

[Cideous]

Ummm dicey.  

 

I would never EVER say anything to the patient.  I was not your mistake and is not your responsibility to tell them and in fact it could actually open you up to liability.  

[MediMike]

It is my understanding that the only liability you'll be opening yourself up to would be defamation by the other provider.  Any delay in notifying the patient of a medical error puts you on the hook for delay of care. Plus...you know..ethics.  I'd get legal counsel for sure but the patient has to be notified asap.

https://www.physiciansweekly.com/how-to-deal-with-another-doctors-error-and-minimize-liability/

Couple of good resources:

https://www.acponline.org/system/files/documents/clinical_information/must_you_disclose_mistakes_made_by_other_physicians.pdf

https://www.acponline.org/system/files/documents/clinical_information/must_you_disclose_mistakes_made_by_other_physicians.pdf

 

[ventana]

nope no way

 

you simply do not know all the facts - and in fact you are likely only getting <50% of story

 

tread lightly as that same patient  might try to sink you....

[Cideous]

19 minutes ago, ventana said:

nope no way

 

you simply do not know all the facts - and in fact you are likely only getting <50% of story

 

tread lightly as that same patient  might try to sink you....

And that is exactly right...and my point.

[mgriffiths]

1. I do not tell patient, as others have said I may not know all of the information (almost guaranteed)

2. Assuming recent, absolutely...I've had to do it.  It is never, "WHAT WERE YOU THINKING?!?!?!"  It is, "Would you be so kind as to walk me through your process because I am confused?"

3. I have, and while it sucks I would do it again.  It is my duty to protect patients, and to turn a blind eye to an impaired provider to support the practice.  To clarify, impairment can include alcohol or some other substance abuse, but can also be an impaired mind from dementia, impaired surgical skills from tremor, impaired medical decision making because a provider has decided to accept non-evidenced based medicine into their practice such as essential oils, dangerous diets, and other untested or worse disproven treatment methods

[rev ronin]

If it's our legal duty to report impaired providers, harm to children or other incompetents, or threats of harm to self or others.

It's our professional obligation to always act in the best interests of our patients. To NOT act in the best interest of our patients is to place us outside the realm of 'medicine' as a profession, regardless of the personal consequences we might face for acting in the patient's best interest.

ETA: I have reported providers before, twice since becoming a PA.  One is dead; the other is no longer practicing medicine. In each case it was because of my own direct observations of the conduct in question, in each case which did not result in direct patient harm but was egregious enough to demonstrate a lack of ability and inclination to practice medicine safely, and not as some third-party whistleblower.  It was not my job to say "What were you thinking?!!" although I could well have done so, it wasn't appropriate in either case.  In neither case was the individual ever brought up before the medical commission.

Edited January 16, 2020 by rev ronin
expanded

[6oo6le]

15 hours ago, ShakaHoo said:

Let's say it is not a life threatening mistake, but results in a permanent impairment of some sort...

Do you say anything to your patient? 

Do you say anything to the other medical provider? 

Would you go as far to report another medical provider?

1.  I would not say anything to the patient as the patient is dead...

2.  I have let the other PA know that the patient passed away shortly and the response was "Thanks for letting me know."  In addition, I continued to observe the PA making clinically questionable mistakes....

3.  Due to the patient passing away as well as the PA's continued lack of clinical judgement, I felt it was my obligation to report to the state medical board...the PA is currently under investigation.  

[ventana]

13 hours ago, ventana said:

nope no way

 

you simply do not know all the facts - and in fact you are likely only getting <50% of story

 

tread lightly as that same patient  might try to sink you....

 

6 hours ago, rev ronin said:

If it's our legal duty to report impaired providers, harm to children or other incompetents, or threats of harm to self or others.

It's our professional obligation to always act in the best interests of our patients. To NOT act in the best interest of our patients is to place us outside the realm of 'medicine' as a profession, regardless of the personal consequences we might face for acting in the patient's best interest.

ETA: I have reported providers before, twice since becoming a PA.  One is dead; the other is no longer practicing medicine. In each case it was because of my own direct observations of the conduct in question, in each case which did not result in direct patient harm but was egregious enough to demonstrate a lack of ability and inclination to practice medicine safely, and not as some third-party whistleblower.  It was not my job to say "What were you thinking?!!" although I could well have done so, it wasn't appropriate in either case.  In neither case was the individual ever brought up before the medical commission.

 

After reading Rev's post - I need to amend mine a little bit to include reporting if they were impaired - I was thinking more along the line of a simple screw up

[thinkertdm]

At the VA, there is a "peer review" process, where the quality improvement people arrange the situation to be reviewed by a peer, who is supposed to rate whether "most providers would do it similarly; some providers may do it differently, and most would do it differently."  The person in question has a formal chance to respond.  

Depending on that finding, it may or may not be elevated into a fuller investigation.

In no case would I ever tell the patient a mistake was made; if asked, I just tell them that there are many ways to approach the problem, and I was not present when x decided upon the plan, and I can't not comment.

On the back end, if I believe that substandard care was delivered, and not simply a variant of care that is still accepted; or if a significant adverse event happened even in light of standard of care, I would tell the quality management folks.  I am not sure if I would discuss it with the provider in question.  It would make no difference in the outcome if I knew of their rationale; someone was harmed and a rca should be performed.  RCA's should be non punitive.

In any case, I am my patients advocate, until told otherwise.  

[Cideous]

1 hour ago, thinkertdm said:

.

In any case, I am my patients advocate, until told otherwise.  

But the way I read it.....it wasn't their patient......

To go outside the loop and insert yourself into someone else's patient/provider relationship?  That's some thin ice man.

Ventana is right though, with the exception of witnessing the provider being impaired in some way.

[MediMike]

The OP's scenario is that the patient is YOURS and you have observed an egregious error/mistake made by another providee resulting in a permanent disability.

This isn't a matter of treating something differently or having a hanky approach. This scenario invokes the issue of frank negligence.

[Marinejiujitsu]

It really depends on the mistake and regardless I would walk wary without throwing someone under the bus. If they are being admitted I defer to the admiting doctor. Sometimes there is no way around it. Such as a surgeon finding an instrument or gauze from another surgeon due to a large abscess building up. Some things you can't get around. I do let the provider know about the mistake. Anyone should appreciate you letting them know because frankly we have all made these kind of mistakes in our career.

Sent from my SM-N975U using Tapatalk

[rev ronin]

14 hours ago, ventana said:

After reading Rev's post - I need to amend mine a little bit to include reporting if they were impaired - I was thinking more along the line of a simple screw up

In one case, the other provider confessed to schizophrenia, active suicidal ideation, and multiple voluntary psych admissions.  This provider was also telling multiple people multiple conflicting stories--as in, things that could simply not possibly be true.  That was a "patients aren't in danger, the provider is" referral.  Interestingly enough, when I called the impaired provider hotline, I swear the guy on the other end was familiar with this individual based on how he reacted to my report.  That is, I suspect someone else had already reported this provider, who may have already been under active supervision, even though I am not privy to whether or not my hunch is correct.

In the other case, the provider had been specifically instructed to not prescribe a particular drug as the SP had decided it belonged to anesthesia, not family medicine. I was later told that this provider continued prescribing it against a direct order, but falsified charts to conceal their continued use of this medication. Upon discovery, they were let go from the practice. Upon providing continuing care for the affected patients, I discovered that among the charts that omitted mention of this medication but where patients told me (and PMP query confirmed) that it had been prescribed to them by this provider, was that of a lactating mother, whose status as such was never documented in the charts, either. At her next visit, she confirmed that no discussion of this drug's safety in lactation had been held.

In each case, I'd consider that far more than a screw up. I've seen people miss things, and had other people find stuff I missed... but there's a difference between being wrong, and being deceptive, which is the common thread between these two cases.

[PA-C]

Two of my patients come to mind when reading this thread.

1.) Patient had a lesion that she disliked for cosmetic reasons. She brought it up to her PCP and said her PCP “did her a favor” and “shaved it off for free” and “threw it in the trash” instead of sending it for pathology, “so she would not get a bill.” A couple years go by and the lesion “grew back” so she came for a derm appointment, again requesting removal “for cosmetic reasons.” I biopsied and the lesion was an invasive melanoma that required referral to surgical oncology. 

2.) Patient came in for a “cyst” on her chest that she said had been there for “at least 3 years.” I lift the drape to examine it and find a fungating tumor the size of a navel orange growing out of her inferior breast. I took a biopsy and it was an aggressive breast cancer that again required referral to surgical oncology. I asked the patient if she had been seeing her PCP for annual physical exams over the last few years and she said yes. I asked if PCP had her get undressed for physical exams and she said no, PCP listened to heart/lungs “through her shirt.” (Not sure if PCP had recommended she get undressed and pt. declined or if PCP was really that lazy). She said PCP HAD recommended mammograms, but she “works a lot and didn’t have time to go.” 

I did try to contact their PCPs (both MDs btw) to let them know what was going on and sent office visit and biopsy records to both, but they never reached back out to me. When I called the breast patient to make sure she had established care with surg onc, she told me she WAS scheduled to see the team I had referred her to, but her PCP told her to cancel that appointment and referred her to someone else.

[MediMike]

1 hour ago, PA-C said:

I did try to contact their PCPs (both MDs btw) to let them know what was going on and sent office visit and biopsy records to both, but they never reached back out to me. When I called the breast patient to make sure she had established care with surg onc, she told me she WAS scheduled to see the team I had referred her to, but her PCP told her to cancel that appointment and referred her to someone else.

Makes you wonder if the group they referred her to may be more likely to cover up for them...

[PA-C]

27 minutes ago, MediMike said:

Makes you wonder if the group they referred her to may be more likely to cover up for them...

Those were my thoughts as well. As awful as both of those situations seemed, I was trying not to pass too much judgement on the PCPs because I only ever had the patient’s perspective. It would have been helpful to speak to them to maybe hear their take of the events that had transpired prior to the patients’ visits with me since patients aren’t always compliant with recommendations or truthful about what went on.

[Reality Check 2]

I have both confronted or engaged the offending provider in conversation regarding issues of care or follow up and I have reported a provider to powers that be for flagrant and dangerous behaviors.

It depended on the situation for me. 

When the provider was one who to could handle collegial conversation - I engaged and we talked things out with both learning something.

The impaired ortho provider was a danger to any he encountered and I found written and radiological evidence of his dysfunction and presented it to Medical Director noting that if it was not acted on by his administration then a letter would be sent to the State Medical Board outlining the danger. They acted.

I could never stand by and watch a provider/nurse - anyone - harm a patient or do something blatantly stupid or inane. 

And I am not good at being quiet...................

[SedRate]

3 hours ago, PA-C said:

Two of my patients come to mind when reading this thread.

1.) Patient had a lesion that she disliked for cosmetic reasons. She brought it up to her PCP and said her PCP “did her a favor” and “shaved it off for free” and “threw it in the trash” instead of sending it for pathology, “so she would not get a bill.” A couple years go by and the lesion “grew back” so she came for a derm appointment, again requesting removal “for cosmetic reasons.” I biopsied and the lesion was an invasive melanoma that required referral to surgical oncology. 

2.) Patient came in for a “cyst” on her chest that she said had been there for “at least 3 years.” I lift the drape to examine it and find a fungating tumor the size of a navel orange growing out of her inferior breast. I took a biopsy and it was an aggressive breast cancer that again required referral to surgical oncology. I asked the patient if she had been seeing her PCP for annual physical exams over the last few years and she said yes. I asked if PCP had her get undressed for physical exams and she said no, PCP listened to heart/lungs “through her shirt.” (Not sure if PCP had recommended she get undressed and pt. declined or if PCP was really that lazy). She said PCP HAD recommended mammograms, but she “works a lot and didn’t have time to go.” 

I did try to contact their PCPs (both MDs btw) to let them know what was going on and sent office visit and biopsy records to both, but they never reached back out to me. When I called the breast patient to make sure she had established care with surg onc, she told me she WAS scheduled to see the team I had referred her to, but her PCP told her to cancel that appointment and referred her to someone else.

Wow. Just wow.