This month’s case involves a charge of negligence against a physician assistant whom the patient believed to be a physician.

The patient, Mrs G, 49, was hurrying to her job as an assistant manager at a bank when her shoe became caught on a section of uneven pavement, causing her to fall to the ground. As she fell, she extended her hands reflexively and landed on them forcefully. A passerby helped her to call her husband, who came and took her to the emergency department of the local hospital.

After evaluation by emergency department staff, Mrs G was diagnosed with an intra-articular fracture of the right dorsal radius, as well as a stress fracture of the left wrist. A temporary splint was applied to her right wrist, and she referred to an orthopedic practice for follow-up treatment.

Two days later, Mrs G and her husband were sitting in the waiting room of the orthopedic practice when Ms M, a physician assistant, appeared and introduced herself. She told Mrs G that she would be treating her today and escorted her to an examination room.

Ms M, 38, had been working at the orthopedic practice for 7 years. She liked the work and most of her coworkers but was wary of Dr P, one of the supervising physicians who could be bad-tempered. If he was the physician on call when Ms. M was working, she tried to avoid asking him anything for fear of being snapped at. Fortunately, she didn’t feel the need to ask too many questions at this point in her career. Most of the work she did was repetitive, and after 7 years, she felt competent in her role.

Ms M ushered Mrs G into the examination room and asked her to describe how she became injured. Mrs G recounted the incident in great detail — how she had caught her foot on the pavement, how she had felt as if she were falling in slow motion, and how she had extended her hands as a reflex to block the fall. Ms M examined the patient’s wrists and noticed that the right wrist had undergone extensive damage. She explained to the patient that the stress fracture in the left wrist would heal on its own by limiting mobility. She took radiographs of both wrists and then informed Mrs G of her treatment options.