Knew the patient was in discomfort but did not make further inquiries
The disclosures made by the patient drive a physician’s inquiry, the Saskatchewan King’s Bench has emphasized in a medical malpractice case.
In Lorencz v. Talukdar, 2022 SKKB 258, James Lorencz died from a heart attack in 2005. His family discovered that he had suffered from undiagnosed cardiac disease. In the months preceding his heart attack, Dr. Sneha Talukdar and Dr. Robert Babchuk saw Lorencz at the Broadway Medical Clinic. His family brought an action under the Fatal Accidents Act, seeking damages for the two physicians' alleged negligence, which resulted in Lorencz’s death.
Shortly before his death, Lorencz saw Dr. Babchuk, who diagnosed Lorencz with an anxiety condition and prescribed an anti-anxiety medication. Lorencz’s wife, Tracy, claimed that immediately after the medical visit, Lorencz told her he was also suffering from upper left arm pain.
When Lorencz completed his prescription, he went back to the hospital, and this time he was seen by Dr. Talukdar, who accepted Dr. Babchuk's diagnosis. Dr. Talukdar gave Lorencz an anxiety and depression checklist and instructed him to complete the form at home. Lorencz saw Dr. Talukdar once more to return the checklist before he died.
Allegedly incomplete notes
Lorencz’s family asserted that Dr. Babchuk’s notes were incomplete and did not contain everything that was relayed to him by the patient. Tracy testified during the trial that shortly after her husband’s visit to Dr. Babchuk, Lorencz told her he was having sweats, nausea, and his arm was hurting. The family claimed that it could be inferred from the circumstances that Lorencz must have told Dr. Babchuk he was experiencing upper left arm pain and that Dr. Babchuk neglected to record this information on the medical chart.
The Saskatchewan King’s Bench observed, “at its core, the plaintiffs are saying, well if he told his wife, surely he must have told the doctor as well. They suggest this is not only a reasonable inference to make, but perhaps the only available inference in these circumstances.”
However, the court ruled that the wife’s recounting of the information relayed by her husband was not, on a balance of probabilities, reliable under the circumstances. The court found that the evidence demonstrates that a patient referring to pain during a medical attendance causes family physicians to listen and record. There was no indication in the evidence that Dr. Babchuk would not have similarly dealt with such a recounting, according to the court.
Knowledge of patient’s pain
In contrast to Dr. Babchuk, who was not informed of the patient’s pain, the court observed that Dr. Talukdar’s notes showed that the patient advised her that he was experiencing pain. While Dr. Talukdar strongly asserted that Lorencz did not refer to his discomfort as chest pain, the fact remained that he identified to the doctor that he was experiencing pain.
The court also found that the patient indirectly advised Dr. Talukdar through the anxiety and depression checklist that he was experiencing pain and other conditions demonstrating potential cardiac concerns.
Standard of care
Citing case law, the court emphasized that a reasonably competent family physician must diagnose a patient’s medical condition based on the current facts that the physician knew or should have known. The court said that the disclosure and discovery of the facts are driven by what the patient tells the physician.
The court further said that the nature of the questions posed by the physician would be determined by the nature of the information presented by the patient. The patient's disclosures drive the physician’s inquiry.
The court found that the visits by Lorencz were designed to be brief attendances and not complete physical examinations. “A physician is not expected as part of the applicable standard of care to go beyond those complaints or concerns,” the court said.
Dr. Babchuk was provided with certain information by the patient, and based on that information, he made a diagnosis. The court ruled that Dr. Babchuk did not breach the applicable standard of care in these circumstances. As a result, the court dismissed the action against him.
On the other hand, the court ruled that Dr. Talukdar failed to meet the standard of care expected of a reasonably prudent family physician. Lorencz had informed her that he was in pain, but the court found nothing on the medical chart to indicate any form of inquiry or discussion to flesh out what this reference to pain meant.
“Having been given certain information, the standard of care compels the family physician make inquiries regarding that information,” the court said.
The court concluded that Dr. Talukdar beached the standard of care in her treatment of Lorencz. However, when the court analyzed causation, it found that Dr. Talukdar’s breach did not cause the patient's death. Consequently, the case against Dr. Talukdar was likewise dismissed.
