Coordinating the care of a patient may literally make the difference between life and death. The involvement of more than one doctors in the treatment of the patient raises the risk that some physicians might have critical information that has to be communicated to the patient and the other physicians for appropriate follow up. Without it the patient may go on without appropriate and essential treatment. The importance of this kind of communication is not necessarily negated if the patient does no return to any of the physicians. Consequently when a physician has information or reaches a determination that the patient should have immediate follow up or treatment it is crucial for that physician to communicate that to the patient and possibly also at least the patient's primary care physician.
Consider the following reported lawsuit. Several physicians had an opportunity to detect the man's prostate cancer before it spread A man went to his family physician and reported having urinary problems. He was 56 at the time. The general practitioner concluded that the problems were not due to cancer even though no testing was done to rule out cancer.
Ten months afterward the individual consulted with a urologist who performed a physical examination on the prostate gland and did a PSA blood test. As it turned out this urologist was not covered under the patient's insurance and so the patient went to a different urologist. The PSA test ordered by the first urologist came back and that urologist advised a biopsy. However, that recommendation evidently was not communicated to the PCP or the urologist approved by the insurance company. The approved urologist did not order a PSA blood test. The approved urologist also conducted a physical examination of the prostate but found no abnormalities and concluded that the patient did not have cancer.
As a result the cancer went undiagnosed for 2 years by which point it had spread outside the prostate. By that point, the cancer had spread beyond the prostate and had metastasized. Had the cancer been diagnosed at the time the patient first complained of urinary problems, when he saw the first urologist, or even when he saw the second urologist, it would have still been contained in the prostate and, with treatment, the patient would have had approximately 97% likelihood of surviving the cancer. Given that the cancer was by now advanced , however, the patient was not expected to live more than five years. The law firm that handled this claim reported that they were able to achieve a settlement during jury selection at trial for $2,500,000 on behalf of the patient.
This case thus shows 2 main types of failures. There was the failure on the part of the general practitioner and the second urologist to not follow the proper screening guidelines. The other error was one in communication. This happened when there was a miscommunication of the findings, suspicions, and recommendations of the urologist who was outside the insurance network and the other doctors. While it is impossible to know if the general practitioner or the second urologist would have followed up on results of the PSA test from the first urologist or on that urologist's suspicion and recommendation they at least would have had information and perspective they were missing.
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