When Missing a 'Zebra' Can Land You in Court

Mark Crane


February 20, 2018

In This Article

Enlist an Expert

As the other attorneys suggested, physicians must consider the "worst first," Hehmeyer said. "If the problem is most likely to be A, but B or C can kill you, you have to rule them out. A doctor isn't required to know everything. That's impossible. But you need to know where to go when you don't have the answer. If you don't know, don't just assume. Know your own limitations and get an expert to help you."

"Defense attorneys always argue the hoofbeats theory, and it's often effective with juries. While doctors were taught about hoofbeats and horses, they were also taught that if you hear hoofbeats but also see stripes, it just might be a zebra. I speak at meetings for several rare disease organizations. Many parents wear T-shirts that say 'Think Zebras.'"

Physicians also win malpractice cases involving rare conditions. "After their mother died of breast cancer, the family decided to sue the doctor," said James Lewis Griffith Sr., a veteran malpractice attorney in Pennsylvania. "We pulled all the mammograms, and the doctor properly interpreted each one. There was no evidence of breast cancer. It turned out the tumor grew on the chest wall itself and metastasized to the spine."

"It wasn't until the patient complained of back pain that they found it. The doctor testified that he can make diagnoses based on findings and symptoms. There was no back pain until much later. You can't x-ray everything. The doctor won the case. Jurors felt that his treatment was within the standard of care."

Where to Go for Help

"I grew up in the Midwest," said Dr Graber. "When there was a problem local doctors couldn't figure out, they'd consult with the Mayo Clinic. Most doctors these days don't have enough time to do a decent history and physical. But Mayo and many other centers of excellence around the country are available for consults and advice."

Here are some other resources:

The National Organization for Rare Disorders has a database with information for patients, families, and physicians about more than 1200 rare diseases. New topics are added regularly along with contact information for physicians who specialize in treating them.

The Genetic and Rare Diseases Information Center (GARD) is a program of the National Center for Advancing Translational Sciences and is funded by the National Institutes of Health. GARD provides the public with access to information about rare and genetic diseases.


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