Dr. K, his face ashen, slowly put down the phone and raised his eyes to his nurse practitioner, Ms. M. In the 15 years that they had worked together, she had never seen him so shaken. “That was about Mr. A,” said the 63-year-old family physician. “He’s dead.”

Ms. M, 39, was equally stunned. A 37-year-old pharmacist, Mr. A had been a well-liked patient for the past three years, coming in for regular checkups and minor complaints.

The clinicians had last seen him four days earlier, when Mr. A came in complaining of chest pain, jaw pain, and anxiety. Ms. M recorded his BP at 140/90 mm Hg, which was consistent with previous readings. At 233 lb and 6 ft 2 in, his BMI was 29.9. Ms. M and Dr. K had been advising


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Mr. A to try to control his hypertension with diet and exercise before resorting to medication.

“I’ve just felt anxious since I woke up, and there’s a feeling of pressure on my chest,” Mr. A reported. “I felt like I needed to have this checked out right away.”

At that point, Ms. M excused herself from the exam room and conferred with Dr. K. They decided that Ms. M should administer an ECG, and they would go over it together. The test was normal, they concluded.

“You’re suffering from anxiety,” Dr. K told the patient. “It’s really quite common and can cause all sorts of physical manifestations. Has work been particularly stressful?”

“Oh, you know how it is,” Mr. A replied. “Everyone needs his prescription yesterday; I have to fill 200 scripts in a day — the usual.”

“Well, just to be safe,” said Dr. K, “I’m going to give you a referral for a cardiac stress test. I’d like you to go first thing tomorrow and have that done. Then we’ll take it from there.”

Mr. A agreed, and Dr. K and Ms. M waved him out of the office, never realizing it would be the last time they would see him.

Ms. M followed up the next day and got the results of the stress test from the cardiologist. These results were also normal. She called Mr. A to pass along the information and advised him to call if he had any other problems or symptoms.

Two days later, Mr. A was at work in the pharmacy when he began feeling the chest pain, jaw pain, and anxiety he had experienced earlier. He called Dr. K, but the office was not open yet, so he left a message. When Dr. K called him back, an hour and 45 minutes later, the paramedics were in the pharmacy, working frantically but futilely to save Mr. A’s life.

The patient’s death at such a young age haunted both Dr. K and Ms. M. Their grief and remorse were compounded when they were served with papers informing them that Mr. A’s widow was suing them for malpractice.

“The widow is saying that you breached the standard of care by not sending Mr. A to the emergency department [ED]immediately,” explained the defense lawyer provided by the clinicians’ insurance company.

“We gave the patient an ECG,” said Dr. K. “It was normal. So was the stress test. There was no reason under those circumstances to think that he was having a coronary incident.”

The defense attorney nodded. “Okay, we’ll go to trial.”

After months of paperwork, depositions, and stress, the case finally went before a jury. Mrs. A described how vibrant her husband had been, how he had provided for the family, and how their three children had relied on their father.

“He was only 37 years old,” the widow said, weeping. “I thought we’d have the rest of our lives together.”

Next, the coroner testified that an MI had caused Mr. A’s death. Last, the plaintiffs’ attorney called a physician who was an expert in family medicine.

“Is it very likely that a 37-year-old will suffer a fatal heart attack?” the attorney asked.

“Not very,” the expert responded.

“What if the 37-year-old had high BP, high cholesterol, and a family history of heart problems?”

“Those would make a heart attack far more likely.”

“If a patient with those issues came to you complaining of chest and jaw pain and anxiety, what would you do?”

“I would advise the patient to go to the ED of the nearest hospital immediately. To do anything else would be to breach the standard of care owed to that patient. Mr. A would be alive today if he had been treated in a hospital when he first exhib-ited symptoms,” the expert asserted.

And with that, the plaintiffs’ attorney rested his case.