Mrs V required several surgeries and was told that had the cancer been discovered earlier, she would have had a better chance of successful treatment. The patient eventually consulted with a plaintiff’s attorney who advised her to sue Ms N and the gynecologist.After hearing that she was being sued, Ms N was upset but believed that she did not have to worry. After all, she had referred the patient to a specialist, so she believed her obligation to the patient was satisfied. The defense attorney provided by her insurance company told her that was not the case.

He hired a medical expert to go over the records. After reviewing the medical records and speaking to Ms N, the expert told the attorney that Ms N appeared to have been reassured by the gynecologist’s finding of benign pelvic disease.


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“This is an example of what we call ‘premature closure,’ ” the expert said. “It seems that once the referral was made, the thinking stopped. Ms N should have focused on a differential diagnosis, focusing on the common causes of rectal bleeding, and this would have likely led to a timelier cancer diagnosis and a better outcome for the patient.”

After considering the expert’s opinion and the costs of trial, the defense attorney recommended settling the case out of court for an amount within Ms N’s insurance.

Legal background

Medical experts are essential in malpractice cases in several ways. First, attorneys use them to help decide whether a case exists, in particular whether or not a clinician has strayed from the accepted standard of care. Second, medical experts are used during a trial to educate the jury members as to what the appropriate standard of care should have been for the patient and to explain the medical terminology to the jurors.

Often, both defense attorneys and plaintiff’s attorneys will use medical experts to help them decide whether to pursue a trial, or whether to settle the case out of court. Medical experts are generally physicians or clinicians in the same field as the defendant (such as nurse practitioners). 

Protecting yourself

Making a referral to a specialist is common in primary care medicine — after all, no one can be an expert in everything. It makes perfect sense that when a patient has an unidentifiable skin problem, he or she would be referred to a dermatologist.

Similarly, a patient who has unremitting stomach problems might be referred to a gastroenterologist. Making a referral is a good way to look out for the health of your patient and as well as your practice, because it allows you to focus on the things that are your specialty, and it allows your patient to get the help that he or she needs. In this month’s case, however, we see what happens when a referral was not the best option. 

Ms N intended to do the best for her patient by referring her to a specialist. Often, that is the right thing to do. But in this case, the patient was actually harmed by the fact that Ms N did not attempt to make a differential diagnosis for the rectal bleeding and abdominal pain and order a CT scan immediately.

Knowing when to make a referral and when to look more carefully into a patient’s problems on your own is difficult. However, it is important to consider all options when diagnosing a patient.

Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, NY.