When doctors and nurses settle on the wrong diagnosis, it is hard to get their attention
Houston-area ER focuses on broken leg, misses broken back, despite patient's complaints that he could not move arms normally
As a Houston medical malpractice attorney, I have handled many cases over the years where doctors, nurses, and hospitals treat one medical problem after a car wreck or other traumatic accident, but entirely miss other medical problems.
That is what happened to a nice man in his 40s from the Humble, Texas area, who recently hired Painter Law Firm to handle his medical negligence case.
For this client, it all started one bad day. He was driving at a slow speed in bad fog, but ended up hitting a tree head-on. The EMTs arrived and took him by ambulance to an area emergency room. The man told everyone who came to see him that he was having bad chest pain and could not move his arms normally.
The hospital did some x-rays to look for broken ribs and leg bones. An orthopedic surgeon came by to see him in the emergency room for about two minutes, and told him that his tibia (the long medial bone in the lower leg) leg was broken but that he had no broken ribs. The patient told him that he was having problems moving his arms. The orthopedic surgeon asked him to squeeze his hand, but when the man could not, the surgeon shrugged it off and said it was just accident trauma that should go away before too long.
It was not long until a nurse came to put an inflatable boot on his leg and get him ready for discharge. The man and his wife asked several times about getting an x-ray, CT scan, or MRI scan of his back, but the ER doctor and nurses said that it was not needed because the chest x-ray was normal. When they asked again, an emergency room nurse said that it was just the hospital’s policy and there would be no more tests.
What to do when doctors and nurses will not listen to you
The standard of care requires doctors to form a differential diagnosis list when taking care of patients. This requires the doctors to listen to all of the history (what happened that brought you to see the doctor), symptoms, and complaints of a patient and then make a differential diagnosis list of each potential diagnosis that could explain the medical picture. Then, starting with the most dangerous diagnosis on the list, rule them out one by one with assessments, examinations, and tests, including radiology studies, like x-rays, CT scans, and MRI scans.
In my client’s case, the doctors and nurses taking care of this man in the emergency room seem to have skipped over every potential diagnosis for a patient who had a head-on collision, including back and neck injuries, and settled on the most obvious diagnosis, a broken leg.
I have seen this happen time and time again. Providers see something benign, like a broken leg, and then go on “auto-pilot,” ignoring other potentially dangerous problems. If you find yourself in this situation, you have to do something to disengage the “auto-pilot” and get them to think about you as a unique individual patient.
Tell your doctors and nurses that you are having other pain and symptoms. Be as specific as possible. If you believe that the nursing staff is not treating your complaints seriously, then ask to speak to the charge nurse or a nursing supervisor. The Texas Board of Nursing requires nurses licensed in the State of Texas to be advocates for their patients, which means that they need to push doctors and argue for care that their patients need.
Similarly, if the doctor seems rushed and ignores your symptoms, then pursue a conversation with him about what is on his differential diagnosis list for you. In my client’s case, for instance, the orthopedic surgeon ignored the fact that the patient could not grab his hand. In such an instance, politely ask how a broken leg could explain this type of symptom. It certainly would not be on the differential diagnosis list.
In addition, when receiving care in the emergency room, bear in mind that the emergency physician is in the role of identifying the specialists that need to be involved in your care, and then receives recommendations from them. In the end, though, it is the emergency room doctor, not the specialists, who makes the decision on what orders to make for you and whether to admit you to the hospital or send you home. Therefore, it is important for you to be thorough with the ER doctor when you are explaining what you are feeling and experiencing during the entire time that you are in the emergency room.
One bad diagnosis often leads to anothe
Back to the story of my client.
After he was discharged home, he started to have some kidney problems and was taken by ambulance to a different hospital. As they got his kidney issue under control, he remarked several times that he could feel pain in his arms and legs but could not move them normally. He also complained that he could move his torso area but could barely move his arms. He and his wife notice that his hands were contractures and looked like he was trying to make a claw position with his fingers.
Despite these issues, the doctors at the second hospital did not order an x-ray, CT, or MRI to figure out what was going on. Instead, they decided to move him to a nursing home for physical therapy.
My client went from one hospital to home, and then shortly after that to a second hospital. The second hospital and its doctors, though, made the same mistake as the first one.
In my experience in handling medical malpractice cases, the doctors and nurses at the second hospital likely made their decision 100% because of the way the first hospital handled the patient. In other words, the second hospital team felt that if the first hospital team did not order imaging, why should they do it now?
This is another example of the dangerous auto-pilot phenomenon. If you find yourself in this situation, you may need to be very assertive with the nursing staff, doctors, and even administrators in the hospital to get a true unbiased evaluation of your condition. By “bias,” I am not suggesting any ill motivation, but only the fact that healthcare providers are often unduly influenced by the conclusions of decisions of prior treaters, whether right or wrong. And these diagnostic short-cuts are terribly dangerous when it comes to patient safety.
An eventual MRI, perhaps too late
After six weeks of physical therapy in a nursing home, the doctor, nurses, and administration wanted to discharge my client because they felt that he was not trying hard enough to cooperate in therapy. In desperation, the man and his wife explained that he was trying his best, and again asked about getting an x-ray, CT, or MRI to find an explanation for his problems.
A physical therapist advocated for him, and the doctor and nursing home finally agreed to send him to an imaging center for an MRI. This shows that one healthcare provider who listens to the patient can make all the different in the world.
When the MRI results were available, a neurologist wanted him taken to a hospital by ambulance. All this time, he had four broken vertebrae in his upper back that were compressing his spinal cord.
At the hospital, a neurosurgeon told him that he was surprised that the first hospital did not do an MRI because simple measures like a neck brace or a steroid injection would likely have solved the problem. After all the time that passed, though, he may have permanent damage.
The neurosurgeon took him to surgery for a four-level fusion. Although the doctor hoped that the man’s arm and leg movement would return quickly, it did not. Now he is facing more rehabilitation care and uncertainty as to whether he will ever be able to use his arms and legs again.
We are here to help
We have handled many cases like this, where a patient and family knew something was seriously wrong, but no one would listen. In fact, we have handled a number of cases where the family resorted to calling 911 for help, when the patient was already admitted to one facility but was not getting the necessary care.
If you or someone you care for has been seriously injured by medical negligence, call Painter Law Firm at 281-580-8800, for a free consultation about your potential case with an experienced Houston, Texas medical malpractice lawyer.
Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. Described by a Houston television station as “Tough as a T. Rex,” Robert Painter’s track record shows that he is not afraid to handle medical negligence cases against any hospital or doctor. Robert Painter devotes his law practice to medical malpractice cases, helping patients and their families who have suffered serious injuries or wrongful death because of medical mistakes and errors.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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