Problem: LOOKING FOR HELP

On July 12, Mrs. Smith had severe pain in the left side of her head while at work. She was not speaking coherently and eventually lost consciousness for a few minutes. She was taken to her physician's office by a co-worker. Mrs. Smith's physician suggested that she get some imaging tests at the hospital's outpatient imaging center to rule out a transient ischemic attack. A medical assistant at the imaging center told Mrs. Smith that her tests could not be scheduled until July 14. Mrs. Smith arrived early on July 14 for her imaging test. On her arrival to the imaging center, a medical assistant told Mrs. Smith, "I am sorry, but we cannot perform your test. Your doctor faxed us an unsigned and undated order sheet. It is confusing to us what imaging studies he wants. He checked a box on the physician's order sheet indicating that he wanted a CT scan of the head.

In addition, there was a handwritten note on the form indicating that your physician wants an MRI to rule out a transient ischemic attack. We are not sure if he wants one or both tests. You will have to get clarification from the physician as to exactly what procedure he wants." Mr. Smith, after having parked his wife's car, arrived at the front desk and saw his wife somewhat distressed. The medical assistant explained the problem. Mr. Smith asked the medical assistant, "Could you please contact the physician and ask him to clarify and fax back to the center exactly what tests he wants?" The medical assistant replied, "We are very busy; however, you can use our phone and ask the physician to clarify his order and have him fax us a new order." Mr. Smith replied, "What is your fax number?" The medical assistant (pointing to a wall) replied, "It is posted there on the wall by the phone. You can use that phone." The medical assistant suggested that Mrs. Smith could complete the patient intake paperwork while Mr. Smith contacted the physician. Mr. Smith was able to get a new faxed order.

Ethical and Legal Issues

1. Should the medical assistant have clarified the physician's order before the patient arrived? Discuss your answer.

2. What would you think if you learned that Mrs. Smith had to wait 48 hours before she could get her imaging studies scheduled? Would your thinking be influenced if the patient were your spouse, parent, or child?

3. How would you feel walking in the patient's shoes and learning that the imaging studies showed evidence of a minor stroke?

4. What advice would you give to both Mr. and Mrs. Smith if you overheard Mrs. Smith say to Mr. Smith, "I know that you would never have believed this happened unless you were there. This is how my last 6 years of life have been in fighting this horrendous disease.