Not long ago, a tort lawyer boiled it all down in a direct question to me, related to a case where someone else’s patient had died…
Were the actions of the physician reasonable given the circumstances?
Whether we are considering communications, behaviors, or decisions; organizations providing healthcare operate within a standard of “reasonable”.
What a reasonable or prudent physician might do…
What a typical patient or family member would consider reasonable…
This is especially important if the patient is leading the provider in a direction that seems reasonable to the patient, but perhaps not if looking at the medical record, or just taking a step back to see a bigger picture.
It also may seem unreasonable in the context of (ever-changing) guidelines. (Exploration of the new Washington State Agency Medical Directors Group or “AMDG” Guideline can be found here in a discussion with Andrew Friedman MD from Virginia Mason, and another with Cindy Grande MD).
Patient relationships are important, but when the patient dies, you can’t ask them to take the witness stand, because they are dead. Their family may rely on the medical record to piece together the circumstances. Given that the circumstances included a bad outcome, are the clinicians actions leading up to that reasonable?
“I’m here for my pain medication, but I can’t afford that sleep apnea test.”
“I’m I’m here for my pain medication, but I can’t get time off work for PT.”
“I’m here for my pain medication, but I took more than the directions allow.”
“If I don’t get my pain medication, I’ll buy it from my neighbor”
When the patient dies, you can’t ask them to take the witness stand, because they are dead