It was another long day for Dr. D, 35, a family practitioner with a private office. To keep the office open as many days as possible, Dr. D was working long hours. But lately, due to financial reasons, his hours were becoming almost unmanageable.

On some level, of course, Dr. D understood. The changing face of healthcare was forcing him to see many patients much more quickly than he’d like. To stay above water, he had to keep the office open as many hours as possible, and get as many patients in and out as he could.

His frustration with the situation was growing, however. Adding to Dr. D’s frustration was the fact that his wife had just had their second child, and needed his help at home, but lately by the time he got home, he was too tired to be of much use. If it weren’t for the combination of his ambition and a fear of not being able to pay his mortgage, he would have shut down his practice long ago. But Dr. D felt loyal to his patients, and just kept doing the best he could.

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One evening, Dr. D was at work when one of his patients, Ms. B, 40, came in. The waiting room was full of patients. Scanning the room, he could feel his stress level increasing, and he quickly asked the nurse to usher Ms. B into the exam room.

Ms. B’s face was swollen and red, and she complained of two to three days of fever and runny nose, which she had self treated with an OTC decongestant. Dr. D looked at her face again. He diagnosed the patient with a viral infection, and told her that it would go away in a day or two.

“Why is my face so swollen?” the patient asked.

“I believe you’re having an allergic reaction to a dye in the decongestant. That happens. I’ll prescribe a mild steroid to help relieve the effects of the allergic reaction.”

He wrote the patient a prescription and quickly ushered her out of the office, motioning for the next patient.

A day later, Ms. B called the office complaining that the facial swelling had not resolved. Dr. D took the call. He looked at his notes and told the patient that he would adjust her steroids and call in another prescription.

Two days after that, Dr. D received another phone call from the patient, still complaining of severe facial swelling, especially around the eyes. Dr. D upped her steroid dosage, and told her to call back in a few days.

Ms. B never called back. In fact, Dr. D never heard from her again until several months later when he received papers notifying him that he was being sued for medical malpractice because he failed to diagnose a bacterial infection. The lawsuit alleged that after the second call to the physician’s office, and despite the heavier dosage of steroids, Ms. B’s face continued to swell as a result of an undiagnosed bacterial infection: orbital cellulitis. By the time Ms. B sought help at the emergency department of her local hospital, she had lost sight in both eyes. Ms. B was declared permanently blind as a result of the extensive untreated bacterial infection around her eyes. When she found out her diagnosis, she hired an attorney and sued Dr. D.

The clinician was horrified and guilt stricken. He met with the attorney provided by his malpractice insurance. She advised waiting for the discovery process to decide whether to settle or not. During the discovery process, it was revealed that Dr. D had spent only five minutes with the patient when she came in. Ms. B was alleging that if Dr. D had ordered a simple blood test, it would have been obvious that she was suffering from a bacterial rather than viral infection.

“I believe we would be better off settling this case,” the attorney said. “Based on what I’ve seen, you don’t stand a good chance of winning, and it would be better to avoid the bad publicity.”

Dr. D acquiesced and the attorney negotiated a settlement which avoided trial. The case settled for $2.4 million, the upper limits of the malpractice policy.