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Makes total sense to me. If you have the power to decide on the treatment and hospital admission of a patient you have a patient-doctor relationship. If they wa

Makes total sense to me. If you have the power to decide on the treatment and hospital admission of a patient you have a patient-doctor relationship. If they want to reject responsibility they also should not have stated an opinion without seeing the patient.

amputect 7y ago
Yeah I came here to write more or less this exact comment -- the doctor absolutely did make a medical judgement on the patient, and frankly it was an astonishingly bad one. To declare, sight unseen, that a patient with several severe signs of infection is simply prediabetic, is negligent in the extreme, especially when the medical professional who is actually with the patient doesn't agree.
- amputect 7y ago
  Also I'd like to point out that the headline is, at best, highly misleading -- the doctor didn't see the patient, no, but that's the problem not an exculpatory factor. This isn't a random doctor being sued by a random patient it's a doctor whose medical judgement arguably led to the patient's death.
- maxxxxx 7y ago
  I am sure they dream of AI diagnosis. It can be optimized for profit and any negative effects can be blamed on the AI.
  - ska 7y ago
    It's more the other way around, at least in a US context. Concern of the impact of AI/physician disagreement is a problem from a malpractice point of view. Physicians in the US have a huge amount of professional leeway - hence the expansion of off-label use - but this is counterbalanced by a large amount of professional responsibility/liability.
- hn_throwaway_99 7y ago
  Moreover, the Dr's argument that he was just "giving an opinion", but did not actually accept or prevent her admittance, absolutely does not pass the smell test. He was in a position of power, and from the description of the phone call with the nurse practitioner in the article it is extremely clear he wasn't just "offering an opinion", but was in fact denying admittance. Honestly, I feel awful for the patient and her family, but I also feel awful for the NP who tried to do the right thing but was shot down by those with greater seniority than her. I hope her employer changes their training so that if something like this happens in the future that they just tell the patient to go directly to the ER.
  - Scoundreller 7y ago
    And to better assert the independence of NPs. At least with this lawsuit and settlement, NPs may be more legally motivated to do the right thing.
    - arkades 7y ago
      The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't. "Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?
      - Scoundreller 7y ago
        I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN). The NP settled their case out-of-court. So they were held liable, and we don’t know how much. The consulted MD felt like fighting it in court, and lost. That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.
arkades 7y ago
I don't want to spam the thread by posting my comment all over it, so I'll ask you to read it downthread. The article highly mis-represents appropriate and routine procedure; the statement that the hospitalist here had the "power to decide on treatment and admission" is factually incorrect, though it's an incorrect impression the article very much tried to leave you with.
TazeTSchnitzel 7y ago
I don't know how it works in US law, but it reminded me exactly of the English tort law concept of “duty of care”, which can exist between two people even without direct contact.
jdoliner 7y ago
> they also should not have stated an opinion without seeing the patient. Doesn't that mean that the doctors choices basically boil down to 1) see every patient that you get a phone call about or 2) don't take phone calls? Given that I don't think 1 will scale very far it seems like most doctors will have to take option 2, I'm not sure if we're better off in a world where this type of consultation can't happen anymore for fear of liability.
- LoSboccacc 7y ago
  it's not either or, there's option 3 "I can't form an opinion over the phone, if your medic thinks this can't wait for standard admittance channels I kindly defer you to the emergency services." and likely others.
  - smackinglyt 7y ago
    Unfortunately, it's more complex than that. I'm a hospitalist at a pair of community hospitals that don't have some services (cardiology, vascular surgery, neurosurgery, ophtho, etc). I'm used to calling the specialist at our associated academic center when a possible acute problem related to those specialities may be happening. If those specialists now refuse to do "curbside" phone consults because they can't see the patient and now can get sued, these patients are in a bad position. The tertiery hospitals here are constantly full and I can't transfer patients that don't have immediate true emergencies. This opinion is a major loss for patients. And I also used to "decline" direct admissions based on phone consults, telling outpatient AP/NPs what I thought would be a reasonable course of action and follow-up. Will simply say "sorry" on the phone now and tell them to send the patient to the ED, where the costs are very high. This will simply jack up the cost for everyone else. Not saying the MD in the news article had a reasonable opinion. But spend a single day with me in our busy hospital, see just how tricky this profession is, and you might be convinced that I need more legal protection, not less.
    - scott00 7y ago
      In the event a primary care/urgent care doc disagrees with a hospitalist on the need for admission, why is sending them to the ED the right move? I was under the impression the ED is mostly for triage, and it seems like patients in this situation have already been triaged. It also seems like the sort of disagreement about the need for admission between urgent care and hospitalist is also going to happen sometimes between ED docs and hospitalists. How do those disputes get resolved?

amputect 7y ago

Yeah I came here to write more or less this exact comment -- the doctor absolutely did make a medical judgement on the patient, and frankly it was an astonishingly bad one. To declare, sight unseen, that a patient with several severe signs of infection is simply prediabetic, is negligent in the extreme, especially when the medical professional who is actually with the patient doesn't agree.

amputect 7y ago
Also I'd like to point out that the headline is, at best, highly misleading -- the doctor didn't see the patient, no, but that's the problem not an exculpatory factor. This isn't a random doctor being sued by a random patient it's a doctor whose medical judgement arguably led to the patient's death.
maxxxxx 7y ago
I am sure they dream of AI diagnosis. It can be optimized for profit and any negative effects can be blamed on the AI.
- ska 7y ago
  It's more the other way around, at least in a US context. Concern of the impact of AI/physician disagreement is a problem from a malpractice point of view. Physicians in the US have a huge amount of professional leeway - hence the expansion of off-label use - but this is counterbalanced by a large amount of professional responsibility/liability.
hn_throwaway_99 7y ago
Moreover, the Dr's argument that he was just "giving an opinion", but did not actually accept or prevent her admittance, absolutely does not pass the smell test. He was in a position of power, and from the description of the phone call with the nurse practitioner in the article it is extremely clear he wasn't just "offering an opinion", but was in fact denying admittance. Honestly, I feel awful for the patient and her family, but I also feel awful for the NP who tried to do the right thing but was shot down by those with greater seniority than her. I hope her employer changes their training so that if something like this happens in the future that they just tell the patient to go directly to the ER.
- Scoundreller 7y ago
  And to better assert the independence of NPs. At least with this lawsuit and settlement, NPs may be more legally motivated to do the right thing.
  - arkades 7y ago
    The NP in this story is one of the people that fucked up. A, because she should have sent them to the ED. B, because hospitalists have nothing to do with the ED, and she was trying to /bypass/ the ED. C, because she didn't need her supervising physician's permission to send the patient to the ED. D, just for kicks, diabetes absolutely causes a white count bump, especially during uncontrolled episodes, with the degree of one correlating to the other - something every med student is expected to know, and it's ridiculous that the NP didn't. "Legally motivated to do the right thing"? She's significantly more guilty than the hospitalist, who is a red-herring in this entire discussion ("I'm not the ED attending. Send her to the ED. The ED attending decides who gets admitted for non-elective admissions. Also, she might need urgent care, so she shouldn't wait the 12-24 hours hold-up that would occur if I admitted her directly." would have been the response of any hospitalist I've worked with) and yet he's vulnerable to a malpractice suit, and the NP is not. What legal motivation?
    - Scoundreller 7y ago
      I dunno how independently NPs can practise in MN. Sometimes they’re always under an MD and anything that happens is that MD’s responsibility. This can be relatively more true if they’re an employee vs. a contractor (at least where I live, dunno about MN). The NP settled their case out-of-court. So they were held liable, and we don’t know how much. The consulted MD felt like fighting it in court, and lost. That’s what makes this case a bit unusual because something bad happened and one person involved thought they weren’t accountable.

arkades 7y ago

I don't want to spam the thread by posting my comment all over it, so I'll ask you to read it downthread. The article highly mis-represents appropriate and routine procedure; the statement that the hospitalist here had the "power to decide on treatment and admission" is factually incorrect, though it's an incorrect impression the article very much tried to leave you with.

TazeTSchnitzel 7y ago

I don't know how it works in US law, but it reminded me exactly of the English tort law concept of “duty of care”, which can exist between two people even without direct contact.

jdoliner 7y ago

> they also should not have stated an opinion without seeing the patient. Doesn't that mean that the doctors choices basically boil down to 1) see every patient that you get a phone call about or 2) don't take phone calls? Given that I don't think 1 will scale very far it seems like most doctors will have to take option 2, I'm not sure if we're better off in a world where this type of consultation can't happen anymore for fear of liability.

LoSboccacc 7y ago
it's not either or, there's option 3 "I can't form an opinion over the phone, if your medic thinks this can't wait for standard admittance channels I kindly defer you to the emergency services." and likely others.
- smackinglyt 7y ago
  Unfortunately, it's more complex than that. I'm a hospitalist at a pair of community hospitals that don't have some services (cardiology, vascular surgery, neurosurgery, ophtho, etc). I'm used to calling the specialist at our associated academic center when a possible acute problem related to those specialities may be happening. If those specialists now refuse to do "curbside" phone consults because they can't see the patient and now can get sued, these patients are in a bad position. The tertiery hospitals here are constantly full and I can't transfer patients that don't have immediate true emergencies. This opinion is a major loss for patients. And I also used to "decline" direct admissions based on phone consults, telling outpatient AP/NPs what I thought would be a reasonable course of action and follow-up. Will simply say "sorry" on the phone now and tell them to send the patient to the ED, where the costs are very high. This will simply jack up the cost for everyone else. Not saying the MD in the news article had a reasonable opinion. But spend a single day with me in our busy hospital, see just how tricky this profession is, and you might be convinced that I need more legal protection, not less.
  - scott00 7y ago
    In the event a primary care/urgent care doc disagrees with a hospitalist on the need for admission, why is sending them to the ED the right move? I was under the impression the ED is mostly for triage, and it seems like patients in this situation have already been triaged. It also seems like the sort of disagreement about the need for admission between urgent care and hospitalist is also going to happen sometimes between ED docs and hospitalists. How do those disputes get resolved?