Accentuate the Positive?

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LNCtips.com: Accentuate the Positive?


There's an old song with lyrics that go..."You've got to accentuate the positive, eliminate the negative."  The song describes how to achieve happiness by focusing on the positive aspects of life while playing down the adverse ones.  However, if you are a legal nurse consultant who is new to medical malpractice case analysis, you'd better not eliminate the negatives because they could be the crux of the case.

"Negative" is the equivalent of "not good" in many situations.  However, the disease model forms the basis of Medicine, so "negative" means "no disease" which is a good thing.  "Negative" and "normal" mean similar things in Medicine. Positive findings are noteworthy, but so are negative/normal ones because they indicate the absence of disease.

Here are a few questions to answer as you analyze the positives and negatives related to the allegations in your cases:

Were test results misinterpreted as normal or negative when they actually were not? Misread CT scans, MRIs, and mammograms are frequent allegations in medical malpractice cases.  Abscesses fester, aneurysms rupture, and cancer grows bigger and metastasizes when physicians incorrectly interpret positive radiographic results as negative.

Are the test results dependent on physician interpretation or technician involvement?  Some tests (bone density exams, for example) require a human being to input patient data.  If the data are incorrect, the test result will be as well.  Did the interpreter of the test recognize the possibility of an error and have another interpreter review the data and/or over-read the results?  Did the ordering physician question the results or take them at face value? 

Did the patient suffer harm because of a misinterpreted test?  For example, fractures are a known complication of patients with severe osteoporosis.  If a bone density test mistakenly shows osteopenia instead of osteoporosis, patient treatment may not be as aggressive, and fractures can result.

When did a physical finding become positive or abnormal?  For example, a 70-year-old man sues his physician for an allegation of failure to timely diagnose prostate cancer.  Did the patient have PSA tests at his yearly physicals?  Did the patient even have yearly physical exams?  Were previous PSA results within normal limits?  Did the PSA results rise slowly over time or precipitously?  Did the physician inform the patient of every PSA result?  Were there any treatment delays on the part of the patient?  It's essential to note ALL prostate exams and PSA levels for this patient. 

Did the physician order or recommend a test according to screening guidelines?  Part of the medical model includes regular screenings for early detection of certain diseases and conditions.  For example, a 54-year-old woman sues her physician for failure to detect colon cancer.  Was there a positive or negative family history for colon cancer?  Did the primary physician recommend a colonoscopy when the patient turned 50 years old? If there was a positive family history, did the physician recommend a colonoscopy before then?  Were other tests ordered such as barium enema, CT colonography, fecal occult blood test, or fecal immunochemical tests?  Did the patient follow the recommendations of the physician?  If so, were the results positive or negative?

Does the particular test commonly produce false positive or false negative results?  False positives and false negatives are test results which are incorrect. False positives and false negatives occur with tests for breast and cervical cancers, HIV, herpes, and other conditions.  Did the patient suffer a delay in diagnosis due to a false negative?  Did the patient receive unnecessary treatment because of a false positive test result?

As you review medical records, you will see lots of positives and negatives.  Focus on the positive and negative results that relate to the allegations in the case.  When you find test results and physical findings related to the allegations, you will know to accentuate both the positives AND the negatives.

Want to learn more about LNC skills for legal nurse consultants?  Check out the Archives.

...Katy Jones