Mrs. G, a patient in her late 60s, had been coming in frequently with minor complaints to a clinician’s group for which Mr. N, a 38-year-old nurse practitioner, worked.
Mr. N liked Mrs. G, but it was difficult to get her in and out of the office in a reasonable amount of time. Mrs. G was a talkative woman who would discuss health concerns in great detail, as well as tell him about her family and hobbies. Usually, Mrs. G would only come in once a year for a wellness check, and Mr. N was happy to exchange pleasantries and catch up on the year’s events. However, over the last 6 months, Mrs. G had been returning every few weeks with different complaints, and the clinician had been forced to stay late at work several times to catch up after spending large chunks of time with the patient.
Mr. N had not been able to find a cause for Mrs. G’s numerous and varied complaints. He was beginning to wonder whether Mrs. G was exaggerating or possibly imagining her symptoms. Still, he always listened and noted her symptoms and tried to come up with an appropriate solution. Over the last several months, Mrs. G had complained of sore throat, a lump in her throat, acid reflux, vomiting, difficulty breathing, a persistent cough, and fatigue. However, she had never exhibited signs of an inflamed throat or a lump in her throat.
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At the latest of her visits, she launched into what Mr. N believed was a familiar stream of complaints.
“I’m so tired,” she said, “I can’t get anything done in the house. I don’t even have the energy to play with my grandchildren. Did I show you pictures of them?”
Mr. N assured her that she had.
“I don’t sleep well,” she continued. “I’m driving my husband, George, crazy because of it. And I feel like I have a lump in my throat, and this annoying cough.” She demonstrated the cough.
Mr. N saw nothing unusual in the patient’s throat and was unable to palpate a throat lump. Despite this, the clinician decided to refer Mrs. G to an ear, nose, and throat (ENT) specialist for further evaluation. A week after seeing Mrs. G, the ENT specialist called Mr. N to report that he was unable to palpate any type of throat lump or nodule. The remainder of the workup failed to reveal an obvious cause for the patient’s symptoms, he told Mr. N.
Mrs. G returned to see Mr. N several weeks later with the same complaints. Ultimately, Mr. N concluded that the patient’s complaints were symptoms of acid reflux and sleep apnea, and he proceeded to treat Mrs. G for those diagnoses. Despite various treatments, Mrs. G’s symptoms did not seem to improve, and she was a familiar face in the waiting room over the next year as Mr. N tried to manage her condition.
After approximately 2 years of steady visits, Mrs. G stopped coming into the office, and Mr. N heard nothing more until the day he received notice that he was being sued for medical malpractice. His former patient had gone to the emergency department one day complaining of difficulty breathing and was diagnosed with stage 4 thyroid cancer. An obstructing lesion was causing respiratory issues. Mrs. G died from cardiopulmonary arrest as a consequence of thyroid cancer and tracheal stenosis 7 months after receiving the diagnosis.
