Internists and family practitioners are the front-line primary care doctors whom we all see for checkups and treatment of routine problems. They are often the first doctors who examine us when we have something serious that may be life-threatening. They also act as the gateways and coordinators of specialty care.
Malpractice can occur with a primary care doctor in three basic situations:
- Misdiagnosis of a serious condition.
- Failure to coordinate care with a specialist.
- Trying to treat a serious condition for which the primary care doctor lacks skills and experience.
Here is more on each of these three topics:
See the link above to our web page on misdiagnosis. See also this True Story about one patient’s fatal experience with misdiagnosis of an infection by her internist – a life that could have been saved by a simple test taken with a Q-tip.
Coordination of Health Care
Coordination of care is a huge problem in American system or non-system of fragmented medical care. The failure of doctors to communicate well with each other and to coordinate their care leads to heartbreaking tragedies, where patients die “for the want of a nail.”
The American College of Physicians, which is the leading society for internal medicine physicians, speaks to this issue in its ethics manual. Here’s what it says:
“A complex clinical situation may call for multiple consultations. One physician must remain in charge of overall care, communicating with the patient and coordinating care based on information derived from the consultations. Unless authority has been formally transferred elsewhere, the ultimate responsibility for the patient’s care lies with the referring physician.” (American College of Physicians, “American College of Physicians Ethics Manual. Third Edition,” Annals of Internal Medicine 117.11 (Dec. 1, 1992): 956.)
It’s a partnership. You’re the homeowner. The general contractor is your main doctor. There may be times when you feel like you should be your own general contractor. If you’ve had a disease long enough, you may feel that you know more about it than your doctor. If so, it’s time to move on to a doctor who knows more than you. You’re not just paying them to be your prescription-writing machine.
Lest you think there is anything radical in my account of the way it’s supposed to work, consider what a group of top leaders in medical-care quality agreed was the top priority for the system at large: “Patients must be at the center of the care system and have the right to coordinated quality care.” (The meeting in 2007 was sponsored by the Mayo Clinic Health Policy Forum and was cohosted by the RAND Corporation. See www.mayoclinic.org.)
In 2007, the leading primary-care doctors’ organizations—representing pediatricians, family practitioners, internists, and osteopaths—put out a document called the “Patient-Centered Medical Home,” which calls for fundamentally changing the fragmented health care most of us receive. The idea of the doctors’ groups is to organize care around a “medical home” in which each patient has an ongoing relationship with a personal physician, who is in charge of a team that provides comprehensive, coordinated care with quality and safety hallmarks like electronic medical records and software that tells the doctor automatically what the latest research shows about the patient’s condition. And the “medical home” also will have expanded hours and easy ways for patients to communicate with doctors, such as via e-mail.
For more, see our web page on communication errors and the patient safety tips for preventing harm from communication failures.
Under-Qualified Care – Failure to Refer to a Specialist
Family practitioners are trained and qualified to deliver babies, but NOT when the delivery is going to be complicated by high-risk conditions in the mother or baby. When a family doctor persists and fails to call in an obstetrician experienced in high-risk deliveries, a tragedy can sometimes result, and can justify the baby’s family in pursuing a medical malpractice lawsuit. More on the childbirth injuries that can make for a valid malpractice case can be found on our web page for birth injuries and related pages on birth injury from asphyxia, cerebral palsy, and brachial plexus palsy.
Another frequent malpractice problem is when internal medicine doctors or family practitioners try to manage a complex chronic disease like diabetes, when they really should refer the patient to a specialist like an endocrinologist.
Here are questions you should consider in looking for a primary care doctor. A top primary care doctor is a vital element in your plan to stay safe and healthy in our fragmented health care system. Read more…
1This passage is adapted from Patrick Malone’s book, The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst. (Da Capo Lifelong 2009).
Consult with an Experienced Malpractice Attorney
If you believe you or a family member has been seriously injured from medical malpractice, medical error, or neglect by a doctor, hospital, nurse, clinic, nursing home or other health care provider, you may want to click here to contact an experienced medical malpractice attorney for a free evaluation of your case. You can also email us at email@example.com or call us at 202-742-1500 or 888-625-6635 toll-free. We will respond within 24 hours. There is no charge for our initial consultation.