Medical Malpractice Case Review – Multiple Biases

Understand medical malpractice cases by looking at the facts.

Case Review

A 65-year-old woman presented to her PCP with nausea, fever, and a dark area in the visual field of her right eye. The PCP performed a physical examination but did not include a funduscopic exam. The PCP diagnosed a viral infection.

Four days later, the woman presented to an ophthalmologist with the loss of central vision in the right eye. The ophthalmologist diagnosed a retinal detachment. The surgery was unsuccessful and she now has permanent loss of vision in that eye.

Discussion

Admittedly, PCPs see many patients with non-specific symptoms of nausea and fever. Most of these patients will have an acute, self-limited viral infection. However, as The Doctor’s Company points out, complaints of acute visual loss are relatively uncommon.

In the above case, the PCP failed to recognize that a dark area in the visual field is a “red flag” for retinal detachment. Funduscopic examination is a routine part of every doctor’s examination of the eye, not just the ophthalmologist’s. Why didn’t the PCP perform a funduscopic exam?

Lack of training? Maybe. More likely is the PCP concentrated on symptoms of the common viral infection to the exclusion of the unusual, but significant, visual complaint.

This could be the result of several biases: confirmation bias, rush-to-solve bias, and overconfidence bias.

• Doctors may only seek evidence that supports their beliefs or expectations due to confirmation bias. This leads to focusing attention on the facts that support the doctor’s conclusion with the exclusion of other information.  Frequently seeing viral infections could mislead the doctor to focus on the symptoms that confirm this diagnosis.
• The strong desire to make a quick decision can lead to a rush-to-solve bias. At times, doctors are in a hurry and often fail to consider all of the possible data before making their decision. Generally, doctors do not get paid more to spend more time on your care.
• Many doctors are intelligent, well-educated people, who are too confident in their abilities. Rather than accepting what they don’t know and referring the patient to a specialist, the doctor comes up with the answer.

Like most cases, the vast majority of patients will be lucky. The PCP’s negligence will not result in permanent injury or death. However, where the patient is permanently injured or dies, the PCP should be held accountable.

Contact us if you would like to have experienced medical malpractice attorneys analyze the facts of your case to determine if medical negligence occurred.