Ch. 1 – The story behind the story

Chapter 1 – A 39 year old woman with multiple complaints

The story behind the story (how we got this case and other interesting tidbits…):

We had the data for 9 chapters and were looking for one more. I had a few appeals decisions, but didn’t think this case was a good one. I called the plaintiff attorney who was very nice but never called me back. I called the defense attorney and he was excited about the project, but wanted to get permission from the defendant – said he would call me back the next day. I had my doubts as there were so many things which needed to fall into place, but, much to my surprise, the records were received right on time and it was the perfect case – had to go first.

Turns out was one of the best cases in the book, and a perfect example of the lessons we were trying to get out; history is king. In fact, all you smart EP’s and MLP’s (me included)… your nurse made the diagnosis. This is one case where ordering tests from your workstation would have been safer than actually seeing the patient!

The icing on the cake was having the defense attorney agree to an interview. He was forthcoming and revealed information about the case which was not apparent from the trial. Then Amal Mattu and Elimie Cobert (my co-author from the EMRA bouncebacks articles) agreed to write a commentary and I knew we had a first chapter. Interestingly, they disagreed on the management of the patient.

I have presented this case at multiple conferences including the all-LA conference Feb. 2011 and invariably the audience feels the physician did not meet the standard of care. I think in the context of a conference with one patient being discussed by 100 participants this makes sense. But in the context of 100 previous patients who actually did have bronchitis, it is not so clear…

Names of characters:

Albert August – A guy I knew a long time ago and ran into recently at a camp reunion – a colorful guy with a zest for living

Plaintiff expert witness – Drew Flora, name slightly changed, very good friend, poker and backpacking buddy. Lives down the street and our kids are good friends!

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