A Whooping Miss

Voiceover: Every minute someone’s life takes a terrifying detour, not down a dark alley, but into the sterile, bright halls of healing. They walk in, seeking care and find themselves plunged into a nightmare. Most malpractice claims in hospitals are related to surgical errors, whereas most claims for outpatient care, which accounts for more than half of the paid malpractice claims, are related to missed or late diagnosis. 

Now, before you raise a pitchfork at every white coat you see, let’s be clear. This isn’t an indictment. It’s a revelation. Because the truth is, any provider, any nurse, any human being capable of brilliance is also capable of a mistake. This is about understanding why and using that knowledge to build a safer future for every patient who walks through those doors. 

Welcome to FHEA’s Scrubs and Subpoenas: Tales from the Witness Stand, a podcast where we’ll peel back the sterile sheets and delve into the real stories of medical malpractice. Each episode a cautionary tale, a blueprint for change, a reminder that even in the darkest corners of human error, there’s a light, the light of knowledge, the light of empathy, the light of a future where health care becomes not a gamble, but a guarantee. 

So, join us as we dissect the mistakes, illuminate the flaws, and ultimately learn to heal not just bodies, but the very system itself. 

Jannah Amiel: Hello and welcome back to another episode of Scrubs and Subpoenas: Tales from the Witness Stand. I am your host, Jannah Amiel and joining me is my co-host and expert faculty and expert witness, which sounds kind of scary, sounds like I need to be in witness protection program, now that I say that out loud. Dr. Sally Miller. 

Dr. Miller, welcome. Thank you for joining me, as always. 

Sally Miller: Thank you for having me. As always. 

JA: Absolutely. Now, if you’re just tuning into this podcast for the first time, we are actually going to talk about real medical malpractice cases. Right. So, these are actual cases that Dr. Miller has served on. And we’re going to talk about these cases in the light of, listen, mistakes happen, right? We know as providers, as practitioners, as clinicians, that things happen and we don’t always do the right things or the outcomes don’t always turn out in the way that we expect it. 

Right. So, these stories, not only are they real cases, but really interesting and really an opportunity for us as healthcare providers and professionals to learn from when things go wrong, quite honestly, right. To learn from that and to think about what are the things that we might be able to do different, what are the things that we should encourage ourselves and our staff right, and our colleagues, our peers to do right now? 

It’s funny because I have a friend, Dr. Miller I didn’t tell you this. I have a friend who said that she saw this podcast, like come across right the whatever podcast platforms that she listens to. And she’s an NP and she reached out and said, “I’m about to go on shift. Before I do, should I listen to this or should I not listen to this? Like, how much is this going to scare me tonight?” 

But you know what? It was a really good conversation because those things are scary, right? And we kind of feel like, my gosh, like we never want this to happen to me. We know we’re not exempt. And more than anything, it really is an opportunity to learn, right? I think it’s an opportunity to learn. 

Do you agree with that? 

SM: Oh, 100%. So often I review these cases and I think, man, I mean, that could have been me. You know, that could have been me. That’s just an innocent miss. You don’t think of something or you do it and forget to write it down. Oh, yeah, 100%. I mean, it can happen to any of us, any time. 

JA: Yeah. And easy things, just as you mentioned just now saying like you forget to write down something like documentation, like documenting a thing, right. Can actually lead to a pretty bad outcome. So, these are really good. I think it’s a good reminder of all the things we learned in school, all the things we learned when we were little tiny practitioners, and little tiny nurses right before we got out there. 

But there’s a real, real reason to that. So, when you’re ready, let’s get into the case.  

SM: I’m ready.  

JA: What you got for us today? And as you listen along, folks, you know, one thing we like to remind you of is try to kind of pick up the things that you are finding. Like, I think that that may have been a miss. 

That may have been a different opportunity we could have done. And it’s also pretty interesting to try to guess, if you will, what side Dr. Sally Miller was actually serving on, you know, during these cases. So, I’m ready when you are. 

SM: I try to present the case in a way that you can’t tell what side retained me, although I realize in retrospect, you probably can. And so, something I’m going to do a little bit differently for today is literally have my notes right in front of me so I can read the relevant things to you directly from the notes. 

You know, there’s that six degrees of separation. There’s a big difference between me telling you my impression of a thing versus me telling you verbatim exactly what the nurse practitioner had in front of him or her when working. So, this case that I encourage everybody who’s listening, you please have to come back and listen to the other podcast as well, because it’s really interesting how you can have the same basic principle housed in two different clinical circumstances with different types of people. 

And I mean, it’s the same basic thing, but it can be perceived very differently by judges and juries depending on the people involved and the rest of the circumstances. And so, this first case, I will tell you this was a really interesting and one and actually it made it all the way to the New Jersey court of appeals. 

And there was a public record available of the appellate court. And it’s really funny and it’s really interesting. So, if anybody’s interested in reading that, just reach out, you know, reach out to us. Sally.Miller@colibrigroup.com. Anybody can do that and I’m happy to share the link with you. 

But here’s the story for people that don’t want to go into the whole appellate position or publication or whatever it is I’m trying to say. So, the thing here, the question here is about standard of care, which is what really most malpractice cases are about. Did the APRN deviate from the standard of care or not? 

And remember that the standard of care in legal jargon isn’t a guideline or anything like that. In legal jargon, it’s what a person of the same training experience and education would do in the same or similar circumstances. So okay, with that said, here we go. So, the patient had just turned 58. 

She was a 58-year-old woman and she had been a patient of this particular outpatient practice for over 10 years. There was documentation in the chart going back to 10 years prior, all the way back to the days of handwritten records that I was trying to tease through. And so, you know, she had been seeing this practice since she was in her mid-forties and, you know, the usual things. 

She you know, she had several visits over the years a lot of times cough, cold, upper respiratory, you know, GI, nausea, vomiting, some of the occasional menopausal symptoms. You know, a fairly typical chart for a woman of that age. No significant medical history, you know. No significant cardiac events or anything like that. And so, on this date, this date in question, she presents to the APRN, who she has seen many times in the past, and she presents with upper respiratory symptoms. 

So, I’m not going to read the entire chart to you. But some of that some of the pertinent stuff here, I can make it invisible on my screen. So, the documentation says she presented with upper respiratory infection. Recent symptoms include post-nasal drip, scratchy throat, and cough was dry, hacking now moist. The condition is acute. I mean, this sounds like a click and pick. 

You know, it’s like a medical kind of medical record. Symptoms began initially 1 week ago, cough 4 days. So, in other words, she started post-nasal drip, the scratchy throat, that kind of stuff, 1 week ago. And then 4 days ago, she developed the cough. The severity is moderate. 

Symptoms are daily, during day and evening. Current medications include antihistamines, decongestants, and a cough suppressant. The problem is exacerbated by activity and position change. Pertinent findings include adequate urine output, cough, post-nasal drip, denies chills, denies fever and denies sinus pain. The APRN acknowledges on a click and pick that she has reviewed the documented medical history, medications, drug allergies. 

The only thing pertinent was that the patient had an allergy to sulfa. She also, I’m sorry, she is allergic to several antibiotics. She was allergic to sulfa, clindamycin, and quinolones. And she also, interestingly had a remote history of C. diff. So when somebody has had C. diff, you know, you’re always a little bit hesitant with the antibiotic thing anyway because broad spectrum, antibiotic sensitive. 

So that was what the NP included in her note that she reviewed these things of which she was aware. The patient denied fever. The vital signs were significant. And let’s see, she was 5’5’’ and 160 pounds. Her temp was 99.0 orally and her blood pressure was 130/80. On physical examination, she appeared well-nourished, well-developed, etc. The NP documented in acute distress due to persistent cough. 

On examination of the throat, there was clear post-nasal drainage, otherwise benign. There were no anterior or posterior cervical nodes. The lungs auscultated as clear bilaterally. The diagnosis was upper respiratory infection and the patient was treated with promethazine cough syrup with codeine, which of course now opioids are evil. But this was several years ago and it was very common to use a cough suppressant with codeine in it, especially in someone like this; who she documents that she’s in acute distress because of the persistent nature of the cough. 

So, the patient was instructed to rest, drink plenty of fluids, use her cough medication as directed since over-the-counter meds had not been helpful and return to clinic if not improving over the next 2 to 3 days. So that’s it. That’s the story. Sounds pretty typical, right? 

JA: It sounds pretty like urgent care visit it. Yeah. 

SM: So, I will ask your audience to give some thought to what conclusion you would draw with that information and in front of you and you know, and be careful to not be thinking, ‘Well, what about this? What if that? What if this? What if that?’ We can’t think that way. We can only look at the information that the NP had on the day of the visit and that’s what she had. 

The patient was long-standing of the practice. She had had over the years relatively regular intervals of upper respiratory infection, the occasional other, you know, acute complaint like nausea, vomiting, etc., some menopausal symptoms. And that was it. She did have numerous antibiotic allergies and she had a history of C. diff. And this is what the NP documented in the note that she reviewed. 

And that’s why I’m highlighting it. Not that we necessarily any of us would go back to a note 10 years ago and zoom in on a certain thing. But for whatever reason, that’s what this NP ordered. Okay, so that’s that. So, then the next thing that happens; that was on the-I can tell you the date, it’s just so long ago. 

In so many years, it doesn’t matter. We’ll say that was on the 8th. That was on the 28th of the month. Right. So that was on the 28th of a month with 31 days. So, let’s see, 28, 29, 30, 31, one, two, three. I’d count on my fingers like the academic that I am. So, 6 days later the patient comes back to the practice and now it just so happens it’s the luck of the draw that she is seen by the physician on that day. 

So, she comes in. He documents present with upper respiratory infection. Recent symptoms include nasal congestion, nasal discharge, post-nasal drip, scratchy throat, hoarseness, ear pain and pressure, sinus pain or pressure, productive cough, shortness of breath, wheezing, and fever to 102.5 the last few days. Secretions are yellow. Yeah. So now she got a fever. Definitely, things are changing. She had been on Mucinex, Tylenol, Advil, Aleve and the cough suppressant. 

She woke up this morning on the sixth day at 4 a.m. with difficulty breathing until she coughed up a big mucus plug. So, he too, acknowledges her current medication of promethazine with codeine. He acknowledges her medication allergies, the various antibiotic allergies, etc. As he goes through the review of systems, he does note the presence of fatigue and fever, but denies insomnia, night sweats, unplanned weight change. 

Pretty much everything else in the constitutional review is negative. He acknowledges the cough and the dyspnea. Patient has no history of asthma or any respiratory phenomena in the office. Today she has a temp of 99.4. Her blood pressure is 120/76, and for reasons unknown, there is no pulse documented. He documents that her ear, nose, and throat exam actually looks totally benign. 

The respiratory auscultation-he says auscultation overall breaths sounds are clear bilaterally overall, no retractions, normal rate rhythm, etc. So, a normal respiratory auscultation, normal cardiac auscultation. Diagnosis: acute URI, cough, fever, not otherwise specified. He orders a chest x-ray and a CBC, probably because the patient (a) is not resolving and (b) now has a fever and is having some shortness of breath and coughed up this big mucus plug. 

So, check a chest x-ray because of new fever and if normal await labs, may well still be viral. Others have had a prolonged course like this. He encourages rest, fluids, Tylenol, all that good stuff. Call if the fever is greater than 101, persists, or the cough becomes more productive or symptoms worsen. So, sends her home. 

That was on the third of the month. And again, so I would ask your audience, you know, ‘Sound reasonable?’ ‘Not reasonable?’ The chest x-ray was read as negative. It was negative for consolidation. So, no viral consolidation, no bacterial consolidation. You know viral pneumonia and bacterial pneumonia, they look different on an x-ray, but this one read as negative. 

They also had both noted in their note that she had had her flu shot 2 months prior. I meant to mention that, and I did not. Her CBC was normal. The differential was within normal limits. There was no elevation of neutrophils or lymphocytes or anything to suggest that there was a bacterial or infectious process. So, guess what happens next? 

If only we had background music or something like that. Obviously something happened next because we wouldn’t be here talking about it if something had not been checked. But what happened next was another 6 day interval for I don’t know why. It’s I guess it’s like things are happening in 6 days here. In 6 more days, on the ninth of the month, the patient called an ambulance. 

Her husband called an ambulance, took her to the emergency department because she woke up in the middle of night and she couldn’t breathe. So now the history that she gives in the emergency room when she is being evaluated there is, she says about 3 weeks ago, after returning from a trip by train, she noted, stinging in her eyes. 

This was followed by onset of cough that was coming in paroxysms. I don’t think I have ever had a patient tell me they had a paroxysm of cough. 

JA: She used that word?! 

SM: I don’t think she did. But that’s what was noted, documented in the note. And I say that a little tongue in cheek, but it is kind of an example of how, you know, every note is somebody’s interpretation of it. You know, unless you’re quoting the patient. So anyway, the cough was coming in paroxysms and was associated with a popping noise. 

Now, the patient probably did say that, you know, who knows. But the cough. So, the cough was really the focus of this HPI. The cough has been present constantly for the last 2 weeks. At times it has been productive of thick green sputum, intermittent fevers to 103, heavy sensation in her chest, no radiation. She has had some nausea and vomiting and diarrhea etc. She was in the hospital and it was a big like, well-known tertiary care center. 

So, they were aggressive in their evaluation. And guess what? Their evaluation revealed. You want to guess? She had pertussis.  

JA: What!? 

SM: She had pertussis. She had Bordatella pertussis. I know. Right. So, then she had pertussis and apparently developed a secondary pneumonia as a consequence. You know, pertussis causes inflammation. 

I really don’t know that it causes pneumonia in its own right. But maybe it does. But the inflammation of the airways renders the patient very vulnerable to secondary infection, whether it’s viral or, you know, like an atypical pneumonia or something. But anyway, I mean, even most emergency rooms that I’m familiar with would not have done this aggressive work-up. 

But it just so happened that, I mean, she was seen by infectious disease and everything. Either her presentation was that bad or it like I said, it’s a major teaching university medical center, and they do tend to be a little bit more aggressive. Anyhow, bottom line is she has pertussis and she’s sick. She’s really sick at this point. 

She is in the hospital. I think ultimately she had to be intubated briefly. She recovered. You know, she got over it. She was treated, she recovered, she was rehabbed and she was discharged to home. So, then there is this-I’m looking for these notes here that I again, I don’t want to tell you my impression. 

I want to read you exactly how it was reported in the documentation. So, she was in the hospital for, I think, maybe 2 weeks. She was hospitalized, briefly intubated, and, you know, and then had to recover. And I mean, you know, when you can’t breathe, of course, it’s pretty, pretty scary. And it’s a slow, steady road back. 

But she was discharged at home. So, this you know, this would be like in February, by February, for sure, of that year, she was home. And in May of that year, another physician consultant documented that she appeared well and without symptoms. So, she was recovered and going back to work. So, she filed a lawsuit against the nurse practitioner and the physician basically saying they should have tested her. 

They should have been suspicious for pertussis and tested and treated it. And what she claims as consequences of this, what she asserts is a deviation of standard of care. I have a list. It’s, I kid you not, four 8.5×11’’ single-spaced pages of bullet points of damages as a consequence of this. Incessant, violent coughing for months, can’t sleep, keeping others awake with the loud coughing, tired and fatigued all day, excessive dryness in the nose, mouth, and throat and needed assistance to be clothed, needed assistance to walk, couldn’t eat or swallow from February till May, had to be fed sips of Ensure, still cannot eat the skins on fruits, lost 25 pounds in the process. I mean I’m just picking out a few of the obvious ones here. Can’t bend down, reach or lift, still has an issue with GERD, inability to clean the house, vacuum, took weeks to walk to the corner, scrolling through pages upon pages of assertions here. 

So, the patient initially did not hire an attorney. Her husband chose to represent them in court.  

JA: And he’s an attorney?  

SM: No, he’s not an attorney. And, you know, we all have the right to represent ourselves in court. You don’t have to have an attorney. It’s just that there are so many you know, there are so many procedural issues that, you know, you could have a good case and blow it because you don’t follow a procedure and it gets dismissed. 

So, I mean, I don’t know for sure, but I suspect that it was perhaps the husband that initially assembled those four pages of single-spaced consequences to try to substantiate. And the amount suing for is $60,000, which I mean, it’s usually a lot more than that people are looking for. Maybe that’s why they didn’t have an attorney. 

Anyway, things kept getting dismissed because he wasn’t making the case properly. So, he finally did find a plaintiff’s attorney to take this to court. And so, they did you know, they got their day. They got-well, they got started in court. So as soon as they finally got into a courtroom, the defense attorney, the one that hired me, moved to have it dismissed based on the fact that there was no evidence that there was a deviation from standard of care. 

And so, the plaintiff’s attorney, the patient’s attorney, found an infectious disease expert that wrote a report and testified the nature of pertussis and how it does present the way that the patient described and had it been treated earlier, she may not have suffered all these consequences. This one expert. But when asked by the judge couldn’t really produce any supporting documentation that not testing for it was a deviation of the standard of care. This case went on for years. 

The event happened in 2012. The patient herself actually died, I think in 2018 of something totally unrelated, completely unrelated to these events. Okay. You know, she died, but her husband continued the case. And finally it was in 2019. So, you know, the court held that there was not enough evidence to support a deviation of standard of care. And so, then they appealed it to the appellate court in New Jersey. 

And the appellate court basically said the same thing and they listed out everything they were looking at. So, it’s really interesting as you read it, how they just sort of teased it apart. But the bottom line is, you know, yeah, she had pertussis, okay? She had pertussis. I think the stats for pertussis or something like 0.7% of the population and it’s much more likely in kids and adolescents, you know. 

Yes. Adults can get it just like we could walk outside and a tree could fall on our head. But the likelihood of it is very, very limited. So, the issue-and there was an NP expert that was hired by the plaintiff who supported the position and said that it was a deviation of the standard of care not to consider pertussis as the differential diagnosis. 

And, you know, it made me sad, actually, to read that. I hope that that person reads the opinion of the appellate court because it’s just so clear. But the bottom line is, you know, we are told over and over again in school and in the evidence, I mean, all sorts of evidence that’s published by the Infectious Disease Society of America, the American Thoracic Society, American Academy of Family Physicians, I mean, it’s all about don’t use antibiotics inappropriately. 

Let’s be judicious. The overwhelming majority of upper respiratory symptoms are transient, viral URIs. And so, this person documented it appropriately, treated it appropriately, especially for someone with all of those allergies to antibiotics. I mean, listen, there was a time and even back then because this happened about 10 years ago, there are still plenty of people that just gave out a Z-pack to people that coughed, you know, because patients want an antibiotic and, you know, a Z-pack was easy to write. 

You know, ‘Z-pak, number one, as dir.’ I mean, it was brilliant marketing on the part of the Z-pack people. But I like to assert that she should have been empirically given antibiotics is just like absolutely flies in the face of everything that is asserted for us in these last years. And so, I mean, it was helpful that the case was not well-presented. 

I mean, it never even got very far. But both the initial judge and the appellate judges were very clear that there just wasn’t enough evidence. And yes, they acknowledged she did have pertussis, but that’s not the issue. You know, lots of times in plaintiff’s cases, they look they make a judgment call based on the outcome. 

I mean, it’s Monday morning quarterbacking. You know, hindsight is 20/20, of course, if you know she developed pertussis, you would say, ‘Dang, wish I had considered that in my differential.’ But we didn’t know. I mean, she didn’t know she had pertussis. She knew that she had 1 weeks’ worth of symptoms that included post-nasal drip and runny nose and scratchy throat and cough, you know, fever, etc. 

And then even 6 days later, when the physician saw the patient and she had a temp and the physician did an X-ray and did a white blood cell differential, I mean, there was still nothing to support it. So, I mean, it was just very crystal clear that there was no deviation from standard of care. And, you know, thankfully, that was acknowledged and the motion was dismissed before it even actually went to be presented as a case in court. 

JA: That is really interesting. And, you know, as you’re talking about pertussis, I would have never, ever guessed it. I have really only seen pertussis in kids just in the pediatric community. So, to be quite honest, I don’t even know. It’s not even a thought, if I’m telling you truth, I’ve never given it a thought. You know, there’s a sick adult like, you know, roaming around. 

But, you know, with that said, like, I know how this goes for peds, but having a missed diagnosis of pertussis, like, can you talk to us about, well, what’s the treatment? And like the, the journey of pertussis anyway? I don’t know it and I could be wrong. I don’t know it to be something that really turns into like a fatal thing for most adults. 

SM: It’s, you know, I haven’t seen it enough and I don’t even think it’s been around enough or well-documented enough to have a good understanding of the fatality in adults. And mind you, this lady, her death had nothing to do with it. She had pneumonia. She was in the hospital. I’m sure it was unpleasant. I’m sure being intubated was unpleasant. 

And then she got better and she went home. And, you know, these assertions about having to be fed and clothed, you know, there are certainly times when people are really hypoxic for a long time and they do need to be rehabbed. And I don’t know how much of it is very literal or perhaps how much it might have been, you know, subjective interpretation. 

You know, what I’m trying to say here in the most delicate terms. But the thing about pertussis is that you just don’t think of it in adults. Now, there was a time some years ago, I think it was after like after these events. But probably while it was in trial that there was a little bit of attention to the upsurge of pertussis in the population. 

Again, the real concern being kids, the real concern being peds. But like this is why the CDC recommends that every adults has at least one Tdap in adulthood. Right. That’s the acellular pertussis piece of it. So, but it’s to protect exposed children. It’s really to protect being around children. So, there is an awareness of a bit of a resurgence in it. 

But you think of it mostly in children and you don’t typically think of it as a fatal condition. And even then, like antibiotic therapy, it’s really controversial. If it even makes much of a difference or not. You know, the primary reason to take antibiotics is to prevent the spread, to prevent communicability of the pertussis. Not so much to protect the patient or improve the patient’s outcome. 

I mean, certainly there is some literature that suggests outcomes can be better because the duration might be shorter, but it’s really, you know, a real kind of iffy there. But, I mean, you know, the point is it just it’s really not in anybody’s differential except maybe after you watch this episode and then think because there is this trajectory of pertussis where initially it does look like a regular old URI. It’s referred to as the catarrhal stage in the first, you know, the first week or so of infectivity. 

It just looks like a regular URI. That whoop, that whooping cough for which it is named, that comes a little bit later. I’ve only ever seen it once even in a child. Only once in my career have I knowingly encountered pertussis. And it was in like a 9- or a 10-month-old baby. And the cough is really distinct. 

Like it is profound. You hear it, you go, ‘What?’ But yes, there is that phase before that where it just looks like garden variety URI. And I mean, let’s face it, unless index of suspicion is really high, like, unless, you know, there was a potential exposure, nobody’s going to think of that. Now, interestingly, in the history of present illness that was reported in the emergency room chart, you know, the last recorded history before she was diagnosed and treated. That business of being on a train and surrounded by people who are coughing, it clearly is meant to represent a history that was characterized by potential exposure. 

And maybe she really just didn’t think about that when the first office visit, because maybe she didn’t think it was significant because she just thought she had a URI. So, it’s very possible that when she saw the NP on the 28th, she didn’t think to mention a bus ride a few weeks ago, or rather, a train ride a few weeks ago. 

But then as time went on and symptoms worsened and an infectious disease team, because it was a teaching hospital, was evaluating her and would undoubtedly ask very pointed questions like, ‘What have you been exposed to anybody with respiratory illness? Have you been in close quarters,’ you know, that kind of thing, and maybe infect her, elicit it, but it doesn’t appear even that the NP knew it and it wouldn’t have made any difference, I’m sure, if she did. 

I mean, you’re much more likely to get URI on the bus from people coughing than you are to get pertussis. So just the absurdity of suggesting that the NP should have considered pertussis as a differential diagnosis and you know this like 58-year-old woman who was having upper respiratory symptoms is just crazy. But I’ll tell you what, one of the other ironies is that the treatment for pertussis is a macrolide, like a Z-pack. 

So, I know, right? So, like a Z-pack, erythromycin, or Biaxin. So, the Z-pack that we’ve been spending years trying to convince people not to give out like candy, I mean. I know. I mean, listen, like I said, I learn something from every case I look at. So, I can’t say that I don’t have a slightly more suspicious eye. 

And if I’m on the fence a little bit, more with the cough, more with something that looks like an acute bronchitis, like cough, cough, cough. It’s always in the back of my mind. But yeah, so that is it. But in the end it was just a simple assertion of deviation from standard of care. And it’s just crystal clear that there was not. 

JA: Yeah. Yeah. I mean certainly stinks for the patient. It sounds like she, you know, she had a rough time, a rough go at it. That’s not pleasant at all. 

At all. I would have absolutely never guessed pertussis, not even with the history of being around, you know, potentially sick people that are contagious. You know. Wow, that’s really interesting. But, you know, with that said to for sure, there is at least one person in the audience right now going, ‘Oh my gosh, I have to test for every single thing when they come in with a cough.’ 

What is your advice to that? And right now, that’s like, alright, I’m whipping out my list of all the possible things it could be. 

SM: This is exactly what we don’t want to do. This is exactly what we are we are taught not to do. That’s referred to as shotgunning. And 30, 40 years ago, that is what you did. It was like sort of a defense mechanism against malpractice litigation. Just test for every conceivable thing and then over the years, we are we are strongly encouraged, encouraged, encouraged not to do that. 

Now, it is reasonable to do a history. It is reasonable to do a good history. And maybe take a minute to I mean, I wouldn’t have thought of this before. I don’t think anybody would have thought of it before not having seen something like this happen as much to help the patient as to protect us from litigation. 

When you’re seeing somebody with the URI it’s maybe worth one or two questions about any and I know this sounds odd, but any chance you’ve been exposed to pertussis or have you ever had your pertussis vaccine that’s, you know, or have you been in an environment where like lots of crowds, lots of people are coughing? And, I mean, if you can check those off, you know, no, I would certainly not want everybody to run out and start testing for pertussis immunoglobulin. 

Yeah, I think I mean really interesting is it that anybody that any attorney took this and that any witness would assert that there was a deviation of standard of care. 

JA: Man and boy, I tell you what, Z-pack is happy for this conversation. 

SM: I know all of us are going to see an upsurge in the prescribing of the Z-pack. No, no, please don’t. Please don’t. 

JA: This was very interesting. Dr. Miller, thank you so much for this story. This was a really good lesson. And that was, you know, that was tricky. And I am not happy, of course, for the patient’s outcome. I understand that she died unrelated, but I am happy that this turned out to not be something that, you know, truly, truly was such a fatal, life-changing thing for this client. 

SM: I mean, sometimes we do everything right. You know, we can do everything right and it still goes wrong. 

JA: Yeah. Yeah. This was great. Thank you so much. Thank you all for listening to this story. We hope that you found it interesting and learned some things from this. And if you enjoyed this podcast, check out the others that we got going on. We hope you’ll join us next time for our next episode of Scrubs and Subpoenas. 

Goodbye for now. 

Voiceover: Thank you for listening and learning with Scrubs and Subpoenas: Tales from the Witness Stand presented by Fitzgerald Health Education Associates. Please rate, review, and subscribe to this podcast. And for more NP resources, visit FHEA.com. Join us again next time as we dissect more medical malpractice cases.