Being Careful in Early Diagnosis
Not listening to the patient was a crucial element that led a Missouri jury to award $29 million last year to a young Springfield woman with Wilson disease that went misdiagnosed for 9 months.
The college senior went to an internist, complaining of fatigue, tremors, panic attacks, insomnia, and other issues. The physician thought that her problems were related to anxiety and depression, and the young woman did have emotional problems, said her attorney Grant Rahmeyer.
Despite repeated requests from the patient and her mother for an MRI and a referral to a neurologist, the physician declined, preferring to adjust the dosages of her anxiety medications. Nine months after the patient first saw the doctor, she complained that her condition had deteriorated, with issues such as acting drunk, falling due to balance problems, and difficulty with handwriting due to the tremors.
The physician relented and ordered an MRI, which showed severe damage to the patient's basal ganglia caused by Wilson disease, a disorder that causes too much copper to accumulate in the liver and brain, according to the lawsuit.
As a result of the delay in diagnosis and treatment, the patient has severe brain damage, quadriplegia, dysarthria, dystonia, tremors, and sporadic contraction of her extremities. It took the jury only 2 hours of deliberation to reach its verdict. "She'll need caregivers for the rest of her life. Had the disease been diagnosed earlier, it could have been easily managed," said Rahmeyer.
"We're not saying that a primary care doctor has an obligation to diagnose Wilson disease. It's hard. But this doctor just wrote off her problems as anxiety when it was clear she wasn't getting better.
"It ought to be med school 101," he said. "Listen to the patient. If something is odd, you need to get to the bottom of it. If the doctor can't do it himself, he needs to make a timely referral. The doctor just anchored herself to the wrong diagnosis of anxiety and depression and then filtered everything through that."
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Cite this: Mark Crane. When Missing a 'Zebra' Can Land You in Court - Medscape - Feb 20, 2018.