 The importance of inter-specialty communication
Of interest to all physicians Good patient care depends on good communication among the members of a team.Where there are multiple conditions treated by multiple physicians, communication becomes more challenging but no less important. It is vital that each involved physician be aware of a patient's progress. A recent case makes this clear. A young pregnant woman developed acute gallbladder symptoms.When these did not respond to conservative measures, a surgeon was consulted. Together the surgeon and obstetrician decided to induce labour as early as possible and to follow with definitive gallbladder surgery. However, a spontaneous delivery occurred and was managed by a nurse before the physician could attend. The obstetrician delivered the placenta and noted a mucosal tear, which he thought needed no treatment. A study the next day confirmed cholelithiasis, and two days post-partum a laparoscopic cholecystectomy was carried out. The patient tolerated that procedure well, but several weeks later complained of passing stool through the vagina. She ultimately required repair of a recto-vaginal fistula by a colorectal surgeon. She sued both physicians, alleging failure to recognize and treat the fistula in a timely fashion. The nurses' notes for the day following delivery show the patient had complained to the nurses of passing gas through the vagina. At examinations for discovery the obstetrician stated it was not his habit to read nurses' notes and he did not do so on this occasion. The surgeon who performed the cholecystectomy also stated he did not read nurses' notes. The patient said she clearly recalled speaking to the obstetrician about her symptoms. Experts stated that whereas early repair is usually effective and not accompanied by significant disability, late repair is more frequently complicated, often requires revision and certainly causes more pain and difficulty. Had either of the doctors read the nurses' notes, it is likely the diagnosis would have been made and the repair would have taken place earlier. As it was, the patient suffered prolonged discomfort and embarrassment before undergoing a difficult late repair. The experts could not support the standard of care provided, and a settlement was paid on behalf of the obstetrician. The Bottom Line
Click to send feedback about this article to the CMPA
DISCLAIMER: The information contained in this learning material is for general educational purposes only and is not intended to provide specific professional medical or legal advice, nor to constitute a "standard of care" for Canadian healthcare professionals. The use of CMPA learning resources is subject to the foregoing as well as the CMPA's Terms of Use.
|
Get 
