Safety of care

Improving patient safety and reducing risks

Gratuitous criticism or "If we had only seen you sooner"

An article for physicians by physicians
Originally published Winter 1995 / Revised February 2008
IL9510-2-E

Abstract

A physician's remarks about prior care may lead to medico-legal difficulties for a previous care provider. It is important to base any comments on a thorough knowledge of the facts.

Of interest to all physicians

Analysis of the Association's experience with legal actions reveals that over 60% of the cases are resolved by way of a consent dismissal. This means that the plaintiff (patient) withdraws the legal action prior to trial and receives no compensation either for alleged damages or for expenses incurred in bringing the legal action.

While this may happen for a variety of reasons, most frequently it happens because a closer examination of the case convinces the plaintiff that one cannot prove negligence on behalf of the physicians involved. Why then were these legal actions commenced?

One reason patients consider litigation, or a complaint to a provincial regulatory authority (College), is related to comments made to them or their families by subsequent health care providers..."if we had only seen you sooner".

Perhaps the physician intended to convey that "if you had been here sooner... the lab would have been open... we would have had a bed for admission... the anaesthetist would not have gone home." The patient or their family, however, interprets this to mean, "if someone had seen me sooner... I would not have been so sick... my condition would have been cured... and, I would now not be disabled".

One such complaint letter to a College reads in part, "Doctor A ordered surgery for my mother on June 17. My mother's ovaries were removed but the cancer was too far advanced and there was not much more they could do. The doctor told us that her cancer had been there only 2-6 months; if a full physical had been done by the family practitioner at the first visit the cancer would likely have been contained and a hysterectomy would have had a high chance in removing all of the cancer".

Patients and their families, during this time of stress, may well interpret these comments in a fashion in which they were not intended. In this case we all recognize that ovarian malignancy is extremely difficult to diagnose and can be a rapidly progressive tumour.

The surgeon making such comments is unlikely to have had first hand knowledge of the patient's condition or of the findings when the family practitioner first examined the patient.

A patient's condition changes and evolves during the course of an illness. Children develop fevers very easily. Some fevers are followed by signs of meningitis. When a very sick infant requires transfer to a tertiary care centre concerned parents, friends and relatives are understandably upset. The child may have been seen by several other physicians in recent days. The relatives' burden of guilt, fear, and anger will only be fuelled by comments about a perceived delay in diagnosis or treatment. In particular, comments of this nature made by staff in tertiary care centres can be misinterpreted by patients and used as the basis for litigation or complaints.

It is wise to fully familiarize yourself with the facts of the case prior to making any comments and recognize that, "it is so easy to be wise after the event and condemn as negligence that which is only a misadventure".1



1 Denning, L.J. - Roe v. Ministry of Health [1954] 2 Q.B. 66 (C.A.)

 


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