Mr F, aged 45 years, was a nurse practitioner (NP) working in the office of a family practice physician, Dr D. Mr F and Dr D had been practicing together for the last 7 years and had a comfortable working relationship.

Dr D had a satellite office from which she worked one day per week, on Wednesdays. On those days, Mr F would see the patients in the main office. The system generally worked, and patients who just wanted to see Mr F would often schedule appointments on Wednesday specifically. Wednesdays could often be challenging for Mr F, who had to deal with his own appointments in addition to squeezing people in who needed to be seen immediately.

One Wednesday, around noon, Ms P, aged 18 years, came in with her mother. They had called that morning and asked to be seen as soon as possible because Ms P was experiencing some strange symptoms. After Mr F ushered them into an examination room, Ms P described her symptoms.

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“I’ve had this bad headache since yesterday,” she said, “and my right arm is tingly.”

She went on to describe her tongue as feeling like it was “asleep,” and a numb right leg. A physical examination revealed nothing unusual, but Mr F was somewhat concerned about the symptoms.

“I’m going to order an MRI, just to be safe,” he told the patient. “I want you to go to the MRI facility right away. At your age, it’s probably nothing, but let’s make sure.”

Ms P and her mother left for the MRI facility, and Mr. F went back to his waiting room full of patients.

After the MRI was performed, Ms P and her mother waited at the MRI facility, hoping to be notified about the results, but they were told to call their family physician. Meanwhile, the radiologist noted that Ms P had suffered an acute stroke and sent the report over to Mr F’s office.

Mr F, busy with patients, did not have a chance to look at the report by the time Ms P called, so he instructed the receptionist to schedule an appointment for Ms P for first thing the next morning to go over the results. The receptionist told Ms P that Mr F would see her the next day to discuss the MRI results.

Mr F fully intended to look at the MRI report before he went home, but the afternoon proved busier than expected and by the time he was done with the waiting room full of patients, he had forgotten about the MRI results, and they sat unopened on his desk.  

The following morning, as Ms P was preparing for her doctor’s appointment, she suffered a catastrophic stroke. She was rushed to the hospital, where she required a decompressive craniectomy and cranioplasty, and she was in intensive care for a week and hospitalized for a month. Ms P lost the majority of her right-side vision and suffered right-side paralysis. She required two years of outpatient rehabilitation but was still left unable to read, write, or speak without difficulty.