Should I tell my friend's doctor about his misdiagnosis?

August 2, 2009 7:19 AM

My friend was misdiagnosed by our pcp. The doctor thought he had the flu, and it turns out he has severe malaria. He's currently in the icu fighting for his life. Many flight attendants see this doctor, and I feel they might be at risk. Should I let the doctor know what's happened to my friend, or will he not be able to discuss his medical history with me?

My friend is unable to talk at the moment, much less contact
the doctor himself, and for various reasons his family is
not involved. Thanks for the advice.

posted by jnaps to health & fitness (20 comments total)

The doctor can't discuss the case with you, but you can certainly inform him of your friends condition, even though he won't be able to respond.
posted by Solomon at 7:24 AM on August 2 [2 favorites has favorites]

My understanding is that the rules only apply to doctors.

So, your friend is not your patient. Therefore, you can give information to a doctor about your friend. However, the doctor give information about your friend to you.

I would think the doctor would want to know, so he can test other patients with flu-like symptoms for malaria. There's no down-side to telling the doctor, and potentially it will do some good, so why not?
posted by Houstonian at 7:26 AM on August 2

(er, the doctor cannot give information about your friend to you.)
posted by Houstonian at 7:26 AM on August 2

Your doctor probably can't discuss your friend's medical condition with you, but I don't see how this requires a discussion. Send the doctor an email or letter informing him that your friend had malaria, not the flu, and is critically ill, and mention your concerns of misdiagnosis for the other flight attendants who see this doctor.
posted by orange swan at 7:26 AM on August 2

The doctor may not be able to speak to you, but there's nothing preventing you from writing a note to the doctor. If you think your ailing friend a) put people at risk unknowingly and b) would let them, and his doc, know himself if he could, then write to the pcp. What the doctor does with that information is up to him.
posted by MonkeyToes at 7:31 AM on August 2

I always thought that primary care doctor was supposed to be made aware when any of his/her patients were hospitalized. Doesn't the PCP have a role to play in care coordination, follow-up after discharge, etc, etc? S/he may not be able to discuss the case with you, but nonetheless definitely needs to know.
posted by Robert Angelo at 7:46 AM on August 2

Are you sure that your friend communicated his symptoms properly and told the pcp he'd been abroad? Only if you were certain of that would I even think of telling the doc.
posted by anniecat at 8:10 AM on August 2

No way for us emergency doctors to know the name of the PCP if the patient doesn't or can't tell us, due to memory lapse, altered mental status, or intubation.

You can tell the doctor whatever you want, but the doctor can't discuss your friend's care with you.
posted by gramcracker at 8:16 AM on August 2

Can you give the PCP's contact information to his doctors in the ICU and alert them to the situation? They may wish to get in contact with the PCP anyway so he can be involved (and the ICU doctors will be in a better position to judge whether the PCP is truly at fault).

I hope your friend pulls through. Good luck to both of you.
posted by lilac girl at 8:40 AM on August 2 [2 favorites has favorites]

You need to be aware that your friend should've told any physician about a potential malaria diagnosis when presenting with flu symptoms. Unless a physician knows that a patient has been in a malaria zone, a diagnosis of malaria would be very low on the list of possibilities. In a discussion with my physician about a trip to Africa, he described a similar case from one of his patients - a woman came in presenting with flu-like symptoms, never mentioned she had been in a malaria risk area of Africa, he treated her for the flu and she nearly died. A risk of malaria can last up to two years after possible exposure. My physician emphasized that the malaria risk must be disclosed when seeing any physician for flu-like symptoms. This is not to say that the physician in your friend's case acted appropriately, but you may want to consider this when pursuing further action (your friend may have disclosed their possible risk).

I'm so sorry that your friend has to go through this - I hope your friend pulls through. Best of luck to you.
posted by bluesky43 at 8:52 AM on August 2 [1 favorite has favorites]

Yes, of course communicate the outcome to the primary care physician. Good luck to your friend.

Anniecat, why does it matter whether or not the friend communicated the fact that he'd recently been abroad? This shouldn't be a question of who is to blame, but of how to avoid such problems in the future..

Bluesky43, the question wasn't "should we sue of file a grievance with the medical board," it was whether the OP can and should communicate with the PCP in case other people are at risk. I think though that the medical profession is pretty broken if a primary care physician isn't expected to take into account basic facts, like what someone does for a living, when pursuing a diagnosis. Particularly in this case, because it sounds like this physician sees an unusual # of patients in the travel industry.
posted by Good Brain at 10:33 AM on August 2

I'm not sure what you would hope to accomplish by notifying the PCP. If that doctor needs to be involved in your friend's care, then that's one thing, but if you're expecting the doctor to say or do anything in response (even/especially apologize) I think you're just setting yourself up for disappointment. I also think you probably over-estimate how much satisfaction you would get from telling the doctor about this, especially when you consider that the doctor isn't going to respond in any meaningful way because of a) privacy laws and b) fear of saying something that could show up as evidence in a malpractice suit.

So, yeah, you're allowed to tell the doctor, but I think you'll be disappointed by the results.



a woman came in presenting with flu-like symptoms, never mentioned she had been in a malaria risk area of Africa

Although your answer doesn't respond to the actual question, I have to wonder how you think a patient is going to know a) that they had been to a "malaria risk area" or b) that such a visit was relevant to the diagnosis (especially two years post). These are things that doctors [are supposed to] know and they are pieces of information that doctors are supposed to elicit before they make a diagnosis.

It takes all of 5 seconds to ask someone if they've been overseas or to a "malaria risk area" in the last two years. Then the patient knows that they should tell the doctor about trips that they've made to places that might be on such a list, and the two can have a conversation about what, if any, of the patient's trips might apply.

Assuming that a patient has disclosed all information relevant to a diagnosis (especially when an incorrect diagnosis could be life threatening) without asking any further questions is expecting the patient to be doing the doctor's job and is stupid beyond words.
posted by toomuchpete at 11:01 AM on August 2

Thanks for all the answers and well wishes. On his first
visit he did not notify the pcp of his trip to Accra. I made
him return the next day and inform the physician, who
then ordered a stool sample. The results would take 4
days to come in; by the next day I had already taken
him to the er, where they discovered the percentage of
malaria in his system to be near 70%. He would have been
dead if we waited for results, and he's still in really bad
shape.

I don't expect any kind of apology from the doctor, but this
form of malaria acts really quickly, and if anyone else
contracts it in Accra, which is a popular trip, I worry that
his course of treatment might put them at risk.

Of course, I also worry that the information won't
make it past the secretary, or that he'll be so defensive
he won't listen.
posted by jnaps at 11:50 AM on August 2

Assuming that a patient has disclosed all information relevant to a diagnosis (especially when an incorrect diagnosis could be life threatening) without asking any further questions is expecting the patient to be doing the doctor's job and is stupid beyond words.

Assuming that a doctor is supposed to guess that a person has been to a high malaria risk zone is stupid beyond words. A million diseases present themselves with flu-like symptoms. Is the doc supposed to go over ever possibility? ("Have you been to Naru? Have you been to India? Is there a chance you came into contact with uranium?") Stop making unrealistic demands and trying to place blame on doctors. This guy could have gone to eight doctors and never once disclosed that he'd been in Accra and gotten the same result. It's not anybody's fault and it's not fair to badmouth the doc.
posted by anniecat at 12:46 PM on August 2 [1 favorite has favorites]

Oh, wow, anniecat, I'm not trying to blame
the doctor. I'm sorry if I gave that impression. It's just like you said, that many diseases
present themselves with flu-like symptoms, and I would
hate for anyone else to go through this. It's rainy season
in Accra, which means higher potential for malaria. If he
knows what to look for, then maybe he could save some
lives. If anything, I blame myself for not taking him to the ER
sooner.
posted by jnaps at 1:19 PM on August 2

Sorry, jnaps, I was talking to toomuchpete, who insists the doctor is at fault.
posted by anniecat at 2:29 PM on August 2

Assuming that a doctor is supposed to guess that a person has been to a high malaria risk zone is stupid beyond words.

That's not what I was suggesting, as any thorough reading of my comment would make clear.

My point was that saying "oh, flu-like symptoms -- must be the flu!" is not sufficient on the doctor's part. The fact that there are, by your estimate, a million diseases that present with flu-like symptoms only increases the importance of a doctor knowing what they are so that they can ask the right questions and get the answers they need to make the correct diagnosis. Otherwise you're saying that every patient should know every disease which could present with their symptoms so that they can know what kinds of information to give the doctor.

I do hope you have a corn field you can put that straw man in, though, so that it actually comes to good use.
posted by toomuchpete at 2:34 PM on August 2

Sorry, jnaps, I was talking to toomuchpete, who insists the doctor is at fault.

I insist no such thing. You might want to go back and take a moment to re-read what I wrote instead of putting words in my mouth.
posted by toomuchpete at 2:37 PM on August 2

Anyone travelling the world should be familiar with at least the common infectious diseases of the region they are visiting. http://wwwn.CDC.gov/travel
posted by neuron at 8:56 AM on August 3

Neuron, everyone should absolutely be aware of the infectious diseases of wherever they travel. Our company doesn't require flight attendants to take prophylactics prior to visiting a malaria endemic area -- mostly because these pills have severe side effects which can prevent flight attendants from working the trip, and also potentially cause liver damage.

Anyway, he did tell the doctor of his concerns with regard to malaria, but the doctor, being a family doctor in an area never really affected by malaria, did not understand the urgency of the situation.

Which, you, know, fine. I'm not looking to pursue legal action here, and my friend isn't the suing type. I'm just worried about others who travel to the region.

So, update: I spoke with the doctor this afternoon after I returned from the ICU. I was surprised he bothered to speak with me, to be honest, but I've been a patient of his for several years. The ICU had not contacted him yet; they've been busy keeping my friend alive for the past week. He apologized profusely, which I was NOT expecting, and promised to be on the lookout for future cases. A day can make a difference between life and death with this strain.

Also, as an aside, something I've learned from this whole ordeal, that everyone talks about but no one really takes care of: PLEASE write out a living will. Dealing with healthcare proxies versus power of attorneys versus family is a complete legal nightmare, especially when everyone would rather focus on the health of the party involved.

And, again, if you live in the US and you've travelled to a malaria region and you feel flu-like symptoms, do not go to a family doctor. Go immediately to an emergency room and demand a test for malaria. Depending on your region, they might not even carry anti-malarial medications, much less consider a test necessary, EVEN if you tell them you might have malaria. It's just not an issue here, and many doctors, even in hospitals, don't understand how severe it can be.

Thanks again for the advice. I don't know that I could have worked up the courage to confront our doctor without your help. Hopefully what he's going through right now will prevent further cases in the future.

Please keep my friend in your thoughts. He has a long road ahead of him.
posted by jnaps at 5:12 PM on August 3