Medical Malpractice

Vocabulary

Medical malpractice /mæl'præktɪs/ 醫療糾紛

Medical negligence /'nɛglədʒəns/ 醫療過失

Discussion

What is the difference between medical malpractice and medical negligence ？

(I don’t mean that the former includes dispute and the latter not.)

Why the medical malpractice will take place ？

Nursing errors Medical negligence (medical error) Poor communication The damaged rapport between doctor and

patient

How to prevent the medical malpractice ？

Doctors must keep in mind that they have the duties of disclosure.

ex ： surgery 、 the patient’s condition Doctors must check the medical records

fully to prevent genetic or allergic diseases. Pay attention to the patients and keep good

communication with them.

Where can medical malpractice possibly take place ？

1.family practice and internal medicine 2.cardiology 3.emergency medicine

4.dentistry 5.ophthalmology 6.otorhinolaryngology 7.obstetrics and gynecology (OB/Gyn)

Vocabulary

Gynecology [‘gaɪnə‘kɑlədʒɪ] The branch of physiology and medicine that deals with the functions and diseases specific to women

and girls, esp. those affecting the reproductive system 婦科學 Obstetrics [əb'stɛtrɪks] The branch of medicine and surgery

concerned with childbirth and the care of women giving birth 產科學

Case Presentation

Introduction

Sally is now 34 years old. She first saw Dr. Diana Cox as a teenager for birth control advice, and off and on over the years for various gynecology needs, including two abortions and one miscarriage.

New phenomenon

She had not seen Dr. Cox for more than five years. However, she made an appointment with Dr. Cox because she was worried about a new “lump” she noticed in her left breast. It had been there for over three months.

Genetics

Her mother died of breast cancer when Sally was a child, so she was silently frantic by the day of the appointment. In addition, Sally had recently married, and wanted to have a family. She mentioned the lump in passing toward the end of the interview with Dr. Cox.

Examination procedure

Dr. Cox was behind in her schedule, exhausted from an early morning C-section, and elected to have her PA examine Sally further. She did order a mammogram before leaving the room.

Vocabulary

PA ： Physician Assistant 醫師助理 mammogram /‘mæmə’græm/ an image

obtained by mammography 乳房 X 光檢查

Examination procedure

The PA noted a small 1.0–1.5 cm mobile soft mass in the left breast, and extensive fibrocystic changes in both breasts. In addition, she ordered a pelvic ultrasound for the finding on exam of an enlarged right ovary.

Turning point

She told Sally that the exam was just routine, and “not to worry. I’ll call you if anything is wrong.” However, before the ultrasound result returned the PA took another job at the local hospital. No one called Sally with the result.

Examination result

The mammogram returned two days later with an indefinite reading of “dense tissue,” and the suggestion of an MRI “if clinically indicated.” A nurse called Sally with the result, told her about the MRI recommendation, but added that “insurance will probably not pay for the MRI.” Sally elected to do nothing more, and felt reassured in general that the problem had been addressed.

Phenomena

When she returned for her follow-up appointment with Dr. Cox one year later, she told Dr. Cox that “she and her husband have been trying to get pregnant, but have not been successful.

Symptoms

It is then that she discovered that her pelvic exam was abnormal. Her cervix showed minor damage from the previous abortions, but the pelvic ultrasound indicated multiple areas of uterine scarring and the possibility of polycystic ovarian disease (PCOD)

Results

Two weeks after that appointment, Dr. Cox performed a salpingogram, with the additional finding of extensive bilateral fallopian tube damage. She is infertile.

Vocabulary

Salpingogram [sæl‘piŋgәugræm] 輸卵管造影圖

Gonorrhea [‘gɑnə’riə] A venereal disease involving inflammatory discharge from the urethra or

vagina 淋病 Trich=trichomoniasis An infection caused by

parasitic trichomonads, chiefly affecting the urinary tract,

vagina, or digestive system 滴蟲症

Reasons

In tears, Sally asked why all of this had happened, and received the answer of “Maybe it had something to do with the previous abortions. Gonorrhea and trich can do this. I just don’t know.”

Rapport has broken

Devastated, Sally made an appointment with Dr. James Jones, a cross-town competitor of Dr. Cox. He wondered aloud if Dr. Cox had caused the various problems leading to Sally’s infertility. Sally then mentioned that a “lump in my breast that Dr. Cox ignored” had gotten bigger.

Medical lawsuit start

Dr. Jones performed an ultrasound-guided fine needle biopsy later that week, which returned malignant. A subsequent mastectomy showed axillary lymph node involvement.

Sally decided to sue Dr. Cox.

Discussion

In this case, which one do you think will win this litigation, Dr. Cox or Sally ？ Why ？

Outline

First paragraph

Introduction ： What is medical malpractice ？ Case presentation ：

Second paragraph

Why the medical malpractice of this case will take place ？ (patient’s viewpoints) Delayed diagnosis of breast cancer Failure to provide the information about abortion

has been used as evidence of an inadequate informed consent.

Third paragraph

When the medical malpractice of this case takes place, what are the actions Dr. Cox must do ？ (doctor’s viewpoints) Mammogram shows there is a dense tissue and

suggests her to do the MRI but Sally elects to do nothing more

The surgery of abortions always damaged cervix and uterus inevitably but it is impossible to damage the salpingo.

Fourth paragraph

How to prevent the medical malpractice in this case ？ Dr. Cox should take Sally’s medical records into

account. Dr. Cox has the duty of disclosure to inform

Sally of a possible risk of infertility.

Last paragraph

Conclusion ： my viewpoints about this case my viewpoints about medical malpractice my expectation for future