What would you do in this situation regarding your family doctor?

As the patient, I would concentrate on getting the best medical treatment possible. I would turn over the ethical and legal issues to a competent member of my family and have them go after the doctor.

That is an unforgivable piece of behavior from the family doctor. Is he still practicing?

Has your relative been in regularly to see his doctor since that test was done 4 years ago? Has he had other tests that came back as being normal? If I was your relative, I would call the doctor and ask them why I was not notified of the abnormal results 4 years ago. Some doctors will repeat tests to see if they get the abnormal results again (to verify the results) and if they did that and the results came back as being normal, that could be why they did not make a big deal of it at the time. I would request to have a copy of all of my records (progress notes, lab results, etc) with them from the time of that abnormal test to the present time.

Also, how abnormal was the result? If it was just above the threshold, and there were some temporary environmental factors that may have skewed the results, it might have been reasonable for the MD to interpret the test as a false positive. Without all of the information it’s difficult to determine fault. @Seaofclouds has good advice, I would take it.

i just got the same result. and did not have a family dr. i trust. Seriously, I would go forward for help.

I would seriously consider litigation.
Hi!

I heard of a case in Mississippi where a woman wasn’t told that there was a problem with her pap. A few years later she found out that she had cancer, and the abnormality had been present on the test all along. She sued the doctor and died before she won her lawsuit.

@gailcalled Yes, surprisingly he is still practicing.
@Seaofclouds My relative is young, only 21 years-old, so he only got his blood and urine test (a full physical) done once, four years ago. He always felt he was healthy, and with kidney disease the symptoms are so subtle there was no reason (or so he thought) for him to go get a full physical every year.
@gorillapaws It was not a false positive. As a matter of fact, when he was rushed to emergency hospital this week, the new doctors saw through computer records of his test 4 years ago that the urine test was genuinely abnormal with protein present, a clear indication that his kidney was starting to deteriorate. The new doctors asked him why he didn’t get help sooner, and my relative told them that he was never informed by his old doctor that anything was wrong with his tests.

@Jewel Yes, my relative’s father is seriously considering suing the doctor. (HI Jewel! Hope you are well!) ;)

@MRSHINYSHOES I’m sorry that he is going through this. Things like this are exactly why people need to have routine yearly physicals. Has he never had any other testing done in the 4 years? I completely understand wanting to pursue legal recourse. If he was 17 at the time of the abnormal results, the doctors office could had also mentioned them to his parents, are they sure they did not hear about them? I hope things work out for him. I do know from personal experience working at a doctor’s office, after trying to call a patient a certain number of times (usually 3) and not hearing anything back from them (as in they don’t return a call when a message was left for them or being unable to leave a message for them), we would send letters informing the patient that they had abnormal tests and they needed to call the office as soon as they received the letter. There were a lot of times we didn’t hear back from them. It’s a slippery slope sometimes.

@Seaofclouds The ironic and dastardly thing is, is that my relative has gone to see the same doctor several times within the last 4 years, not for physicals, but when he had a bad cold, the flu, asthma, etc. You’d think the doctor would have looked over my relative’s most recent blood and urine tests just to see where he’s at physically. But he never did that, not even one mention. :(

@MRSHINYSHOES That really sucks. His parents should request a copy of his medical records, then once they have the records, question why they didn’t get notified of the abnormal results from 4 years ago. I hope your relative is able to get better.

Half the doctors practicing were in the bottom half of their class. You really have to try and stay away from those. If you get one, you need to do what you can so that others don’t. Now that there is the internet, you can advertise what happened, with his name attached, and just describe the situation. Let people make up their own minds. The legal route is problematic, stressful, and won’t actually achieve the goal of having patients avoid him.

@skfinkel While I agree it’s good to alert others, you must have the facts first. If @MRSHINYSHOES was to do something like that and the doctor’s office did infact talk to the 17 year old about it, but he forgot or blew it off (not saying that is what happened, just a what if type thing), the doctor could then possibly sue @MRSHINYSHOES for slander (or mayber some other charge). The legal route could lead to the doctor losing his license which will keep patients away from him. Posting something on the internet will not do that while people have insurance that requires them to use certain doctors.

Well, I’m an attorney so you can guess what I would do.

“First do no harm.” I believe withholding health information to be just that—an opportunity for harm. You cannot make an informed decision about a health problem of which you are not advised.

@MRSHINYSHOES I realize the test wasn’t a false positive, but it’s possible that the MD may have had good reason to interpret it that way. It’s also possible that a staff member in his office dropped the ball and never got the results to him. It’s also possible that the MD is incompetent. Without the facts it’s difficult to evaluate the situation. Which is why I suggested following the advice of @Seaofclouds: get a copy of the records.

@gorillapaws Then the MD actually interpreted it (if he did at all) wrong. The new doctors at the hospital said the test results 4 years ago were so obvious that the original doctor couldn’t have missed them. Therefore the doctor was negligent. Even if a staff member in his office dropped the ball and never got the results to him, it is still the physician’s responsibility ultimately for following up and keeping up with what’s going on with his patients. It is his patients, not the other staff’s.

@MRSHINYSHOES the more info you provide, the more it’s looking bad for the PCP. It does sound like this is probably worth consulting a malpractice attorney about. If they think you might have a case, they’ll send the chart to 1–3 other physicians to get multiple opinions on whether the decisions the MD made were within the standards of care. Their responses will likely determine the direction of the case.

I would point out though that while it is ultimately a MD’s responsibility for the wellbeing of her patients, a Doctor depends on her support staff, because it’s physically impossible for them to double-check that every task is being completed perfectly. Primary care physicians see around 20–30 patients a day, plus they have to read new medical literature, meet with drug-reps to stay on top of the latest treatments available, contact physicians regarding referrals they’ve made etc. It’s like a space shuttle launch, sure the mission control head-guy is ultimately responsible for the safety of the mission, but I can guarantee that he’s not the one double checking that each O-ring is sealing properly.

@gorillapaws And this is one of the reasons why people aren’t choosing to go into primary care anymore…

@Dr_Dredd As I’m sure you know, it’s not just primary care. I was warned from an early age not to get into medicine by my father, who is a general/vascular surgeon.

I will say that in this particular instance, it does sound like the PCP dropped the ball. Although if the patient wasn’t coming in for annual checkups then the line gets fuzzier. What’s your gut reaction to this case (given the incomplete information we have)?

@gorillapaws Yeah, I know it’s not just primary care. But I’ve just had a really crappy day at the primary care office. :-)

I’ve got a number of questions about this case:

1.) As you pointed out, we don’t know how “abnormal” the protein result was. “Trace” protein in a single urine sample would be very different from 4+ proteinuria.

2.) Apparently the young man hadn’t had a physical exam in the four years since the previous test. Had it been recommended that he have one? @MRSHINYSHOES states “He always felt he was healthy, and with kidney disease the symptoms are so subtle there was no reason (or so he thought) for him to go get a full physical every year. ” If a full physical had been recommended annually, might the urine test have been repeated at follow-up?

3.) What exactly did the new doctors tell @MRSHINYSHOES and the rest of the family? And what was the level of training of the new doctors? We have the quote “The new doctors at the hospital said the test results 4 years ago were so obvious that the original doctor couldn’t have missed them. Therefore the (first) doctor was negligent.” Hindsight is often 20–20, obviously. Did the new doctor mean that the results four years ago were blatantly horrible, or were they at a level that only look bad now because the overall clinical outcome is poor? (E.g. was the protein at a level that could have been a false positive years early, but is “obviously” bad now only in retrospect?) And, frankly, if the current doctor is a young trainee, I’d take his/her opinion with a grain of salt.

If I were the patient in question, I’d want to sit down with the original doctor and go over the results from several years ago. I’d also ask for a copy of the old and new records, and potentially get a second opinion.