PART 1: Skipping Thorough Testing.
When a patient comes to you or your medical practice with symptoms that suggest a neurological condition, meeting the standard of care requires a doctor to perform a neurological testing and a thorough assessment to determine if a neurological dysfunction exists, what part of the neurological system is affected (including motor, sensory, cranial nerves, or a combination of them), and to rule out different possibilities on the differential diagnosis list, starting with the condition that would be most dangerous to the patient.
A brief description of the Neurological Test
The key to performing an efficient neurological examination is observation. By simply observing the patient – how he/she speaks, thinks, walks, moves, and simply interacts with the examiner, a skillful observer will already localize a lesion. Dr. Ralph F. Józefowicz (MD), outlines in his article “The five-minute neurological examination” the right order and components for a practical and comprehensive neurological examination:
1. Mental Status
2. Functional Motor Examination
3. Sensory Examination
4. Visual Fields
5. Coordination
6. Reflexes
Are you being careful enough?
Michael J. Aminoff (MD), shared his opinion in the Journal of the American Medical Association (JAMA Network), stating that “neurologic examination is an art already being lost as physicians are becoming increasingly dependent on radiology, computerized and lab studies. Even some doctors ignore a patient’s troubling signs and symptoms that are right in front of them, in favor of computer-generated lab or radiology reports, which take less time and effort than a proper complete physical test”.
Neurologic examination is the first step in diagnosing your patient if there are signs of a neurological condition.
Good medical care begins with an eyes-on physician examination, which guides further testing and care.
There is nothing wrong with performing additional testing on your patients in the quest of finding the correct diagnosis, but it should never supplant the clinical examination. More so, if a detailed clinical test took place at first, they might come as unnecessary and be avoidable (thus saving time and money). Healthcare providers are frequently over-relying on technology, dismissing their own skills and senses to perform the test.
The neurologic examination is considered by many to be overwhelming. It may seem time-consuming, overly detailed, and even capricious. But it’s not that tedious if it may save you from a malpractice claim.
You could get involved in a lawsuit if you misdiagnose a patient.
According to law, doctors must perform their duties consistent with what the medically accepted standard of care would dictate. Under this doctrine, doctors need to administer care consistent with what another physician in the same field of expertise would render in a similar situation.
If you fail to order necessary medical testing, the patient might be able to pursue a legal remedy by filing a medical malpractice lawsuit.
When the right medical tests and physical examinations of the patient aren’t performed or ordered, a patient’s health condition might be overlooked. This can lead to severe harm and even death to the patient, and a serious lawsuit for you or your practice. Take, for instance, the case of a South Carolina patient dealing with multiple side-effects of an auto accident. The neurologist performed an MRI which came back normal, so the patient was dismissed with an undiagnosed brain injury (TBI), which could have been identified with a proper 5-minute neurological testing. Now this neurologist could be facing malpractice claims for misdiagnosis and potential medical negligence.
Every medical malpractice case is different and includes its own unique circumstances, but researchers have identified certain commonalities in events studied. A 2006 study in the Annals of Internal Medicine looked at more than 300 closed medical malpractice cases that alleged a missed or delayed diagnosis. The researchers found that failure to order an appropriate diagnostic test, which occurred in 55 percent of cases, was the most common diagnostic error.
If you as a doctor, fail to order necessary medical testing and make an accurate and timely diagnosis of a harmful medical condition, the patient might be able to pursue a legal remedy by filing a medical malpractice lawsuit. The key question in these kinds of cases is whether the healthcare provider breached the applicable medical standard of care under the circumstances. In other words, "would a similarly trained doctor in the same medical community have spotted the health problem (or identified it within a shorter period)”?
Were you aware of the great importance of performing a thorough neurological examination?
Join us in PART 2 of this article to learn all the reasons why you or your medical practice could be in jeopardy. Can you guess what it is about?