Take-home Message

How to deal with negligence in healthcare

(Fictional narrative by the doctor)

James Fleck, MD, PhD: Anticancerweb 17 (12), 2019

Milton had recently moved to southern Brazil for professional reasons. He was 47 years old, born in a small country town and married Doris twenty years ago. They had three children. He was the main provider, but his wife used to help support the family, working as a part-time teacher in a public school.

Milton was the son of an African descent mother with a father who had Dutch ancestors. He was a green-eyed mulatto, friendly, charismatic and extremely creative. He used to work in computer science for a multinational company. He was responsible for the development and implementation of various innovative software in administrative and scientific areas. He had been transferred to southern Brazil because he was involved in the implementation of a system specifically built for a large Brazilian exporter of manufactured goods.

Two months before his transfer, he began to complain of lack of appetite, nausea, abdominal pain and weight loss. In fact, he had lost about eight pounds in the last month. About ten days before his trip, he reported an episode of dark vomiting, immediately seeking care at a private clinic. He was seen by a gastroenterologist who ordered laboratory tests and requested an upper GI endoscopy.

On the scheduled date, he collected the exams and performed the endoscopy.

The doctor informed him of the presence of an ulcerated tumor located in the stomach. He performed a biopsy and instructed Milton to return within a week to find out the pathological report.

His family had already moved and settled in the new home, awaiting Milton's arrival. They were unaware of Milton's health condition.

When Milton came to me for his first appointment, he was very upset. He came to the office by himself and mentioned that he would like to bring his exams with him, but unfortunately, they were lost.

He told me about his most recent medical history and said that access to his clinical data had been denied. He insisted, justifying that a nontransferable professional commitment would require his immediate relocation to another city. He also mentioned that he would like to continue his treatment closer to his new home address.

He was initially informed that the tests could not be removed from the clinic, that the attending physician was not available and his clinical data had not yet been recorded. After repeated attempts, Milton was informed that all his exams and materials had been lost and that he should undergo a new evaluation.

Milton asked for the name of the laboratory where his biopsy would have been sent. He made personal contact with the clinic-appointed laboratory, who reported never having received his material before.

He was shocked by the answer and asked for my advice.

I told him not to return to that clinic.

The professional attitude did not inspire credibility. They have been careless in handling his biopsy sample, disguising and underestimating the mistake.

I informed that the report and pathological materials belong to the patient and should always be available. Pathology laboratories are responsible for storing all materials, including his biopsy. However, the patient can always request for a biopsy material review in another laboratory, providing only a signed document assuming responsibility for returning the material after the review. However, his case would show an aggravation, considering that the pathology lab reported not having received the material.

I explained that even making contact and getting feedback, the data would not be reliable. In addition, the information that was verbally passed to him required immediate action and we would not spend time trying to recover inconsistent data.

I suggested restarting his investigation as soon as possible.

At the right time, I would help him in organizing his exams and materials. I suggested classifying the imaging exams and reports in chronological order. They deserve the same care that people used to have with civil documents. Often, medical evaluations require comparison with previous exams and they should never be ruled out.

Milton thought for a moment and nodded.

I reviewed his entire medical history and requested his permission to perform a physical examination.

He was a previously healthy man, still maintaining good physical condition, despite recent weight loss. He presented signs of anemia, but no symptoms.  There were no other relevant findings on his clinical examination, except for a light pain after a deep pressure of abdominal epigastric region.

As I left the exam room, I wondered about this unusual situation.

I had been practicing medicine for over thirty years, and it was the first time I had heard of the loss of exams and materials. I could even understand that these pitiful errors could eventually occur. But what I could not accept was the arrogant and hypocritical attitude of the professionals. They should have recognized the existence of a problem and suggested an alternative.

Technological advances have enabled the migration of patient records to more reliable electronic systems. Usually, patient's data is locally stored in own healthcare facility's IT system. More recently, several multinational companies are already developing products that allow virtual data hosting. This is a fascinating field of research on behavior's change called open cloud computing IT. It can be defined as a system where software functions, data processing and storage are in only one location of the network and can be accessed remotely over the Internet.

Let's explore some additional creativity!

Using open cloud computing IT and a strong non-transferable username and password chosen by the patient, the information contained in an electronic medical record can be made available immediately anytime and anywhere in the world.

I kept thinking about these ideas for a while.

I returned to the examination room.

Milton was calm.

He realized that despite having a negative experience, there was a way to correct the problem.

I described in detail the findings of his physical examination. I explained its limitations and the need to repeat upper endoscopy. I sent him to a gastroenterologist and assured Milton that I would follow him throughout the exam, providing real-time information and tracking his biological materials.

Milton thanked me and, to my surprise, asked: “Doctor, why doesn't medicine make the patient's record available over the internet?” 

He added: “I've done a lot of software for banks and credit cards. If people trust their money to these systems, why not trust a greater good like healthcare?”

I was shocked and I said: “Milton, although it seems unorthodox for a doctor to express himself this way, I don't understand how could you read my thoughts? I was just thinking about this.”

Milton expressed a wry smile and stated categorically: “Yo no creo en brujas pero que las hay, las hay!”

To be continued in PLOT 2 (raising action) …

* Attention: The story 5 will be published sequentially from PLOT 1 to PLOT 6 and you will always see the most recent posting. To read Story 5 from the beginning, just click in the numbered links located at the bottom of the homepage. 

© Copyright Anticancerweb 2019 

James Fleck, MD, PhD: Full Professor of Clinical Oncology at the Federal University of Rio Grande do Sul, RS, Brazil 2019