As more dermatology clinicians find themselves increasingly exhausted, being in a hurry can lead to legal repercussions.
“Dr Hurry” is a dermatologist working in a very busypredominantly medical dermatology office. He sees an average of 60 patients per day, is booked for weeks, and does not have a moment to breathe with his busy schedule. In fact, he does not even have enough time to take a patient’s medical history.
Although he loves the practice of dermatology, he finds himself increasingly exhausted. One day a 30-year-old male patient presented to the office with a burn on his finger. The patient, who worked in a nearby chemical plant, told the physician assistant that it was a chemical burn caused by hydrofluoric acid. The assistant, in turn, relayed to Dr Hurry that the patient had a burn on his finger and nothing more.
Dr Hurry grabbed the patient’s file on the way into the examination room and did a quick scan of the nurse’s notes. He did not ask any questions. He diagnosed the patient as having a second-degree burn and prescribed the use of topical antibiotics. At no time did he ask the patient about the source of the burn—he was too busy to do so. However, Dr Hurry discussed the importance of work safety with the patient as he made a note in the patient’s file about the burn. He assured his patient that all would be fine.
Over the next few days, the burn-induced damage worsened. Although the patient’s condition deteriorated every day, he was assured by the memory of Dr Hurry’s lack of concern. By the end of the week, his finger had nearly self-amputated. At that point, the patient saw another dermatologist. This time he directly told that physician that the burn had been caused by hydrofluoric acid. The second dermatologist, seeing the extent of damage, sent the patient to a burn center. Unfortunately, treatment was unsuccessful, and ultimately the patient’s finger was amputated midknuckle, making it difficult for him to work. The remaining part of the finger became very sensitive to heat and cold.
The patient became increasingly angry and bitter toward Dr Hurry.
On the advice of a friend, the patient sought the counsel of a plaintiff’s attorney. “If I had been treated properly by the first dermatologist, I would never have lost my finger,” he told the attorney. The attorney took the case and filed a lawsuit against Dr Hurry.
Dr Hurry was shocked when he received notification that he was being sued. He met with the defense attorney provided by his insurance carrier and explained the situation. “Neither my assistant nor the patient ever told me he was burned with acid,” said Dr Hurry. “Is it my fault that the patient did not give me the full details as to what was wrong?” The attorney agreed that he did not believe that Dr Hurry did anything wrong, but he warned him that juries are notoriously unpredictable and that going to trial is always something of a risk.
“I don’t care,” said Dr Hurry. “I will take the risk. I did not do anything wrong.”
After months of discovery and paperwork, the case finally went to trial.
At trial, the plaintiff’s attorney argued that Dr Hurry was negligent in his treatment of the patient. Just as a doctor would not rely on a patient’s self-diagnosis when determining a treatment plan, a doctor should also not rely on his staff’s description as to the source of a burn. It is the doctor’s responsibility to ask questions and obtain the necessary information.
The patient testified that although he had not provided the source of the burn to the physician, he also was never asked by the physician. Further, he noted that he had given the information to Dr Hurry’s physician assistant.
The jury returned after a brief time in deliberation with a verdict against Dr Hurry.
Dr Hurry did not provide the correct treatment for his patient. He relied on his staff for information, and he never asked the patient the correct questions.
In a case such as this—in which a patient was injured at work by a substance and identified the source of the burn to Dr Hurry’s staff member—the onus was on Dr Hurry to ask about the cause. It is not the plaintiff patient’s responsibility to repeat his conversation. Similarly, Dr Hurry cannot push the onus onto his staff member for not disclosing all the details of the burn. Lastly, Dr Hurry cannot say he was too busy to ask the right questions. He was liable, and the jury agreed.
David J. Goldberg, MD, JD, is medical director of Skin Laser and Surgery Specialists of New York and New Jersey; director of cosmetic dermatology and clinical research at Schweiger Dermatology Group in New York, New York; and clinical professor of dermatology and past director of Mohs Surgery and Laser Research at the Icahn School of Medicine at Mount Sinai in New York, New York.