Urologist's Cursory Exam Misses Fournier's Gangrene

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					www.renalandurologynews.com                                                                                      MARCH 2009              Renal & Urology News 27

                                                  LEGAL ISSUES IN MEDICINE

                                            Urologist’s Cursory Exam
                                            Misses Fournier’s Gangrene
                                            When practical pressures mount and you’re not completely
                                            blameless, mediation may be the best way out of a mess

    BY ANN W. LATNER, JD                      The patient’s sister, his only rela-   case—if the plaintiff was agree-        to settle because the disruption to
    Dr. V, 42, opened his own urolo-        tive, consulted a plaintiffs’ attor-     able. He explained that the media-      his practice was becoming a hard-
    gy practice after several years of      ney who in turn called an expert         tor—usually a lawyer appointed          ship and because he recognized
    working in a large clinic. Now, a       urologist to determine if there was      by the court or local bar associa-      that he had some liability in
    year after setting up his own           a case to be made. The expert            tion—would discuss the case with        Mr. D’s death.
    shop, he was finding there were         explained that Fournier’s gangrene       both sides and help them come to
    some downsides to being a solo          is a form of necrotizing fasciitis       a settlement.                           Protecting yourself
    practitioner.                           with symptoms including pain,              Dr. V was visibly relieved. “That     In this time-means-money world,
      Overhead costs for the office—        swelling, pus, odor, and extreme         sounds like a good solution. I did-     physicians may be pressed to see
    including a receptionist and mal-       tenderness. It is most likely to                                                 too many patients in one day, and
    practice insurance premiums—            develop in men aged 60-80 years;                                                 they don’t get to spend an ade-
    were substantial, and Dr. V was         men with a predisposing condi-           A 66-year-old                           quate amount of time with each
    forced to squeeze in many patients      tion, such as diabetes, obesity, or      man had a scrotum                       individual. Dr. V was rushing
    each day to make ends meet.             immune system disorder, are most                                                 through his exams to maximize
    Sometimes this meant he couldn’t        at risk.                                 “roughly the size                       his flow of patients. Had he
    spend as much time with a partic-         “Do you think Mr. D’s death                                                    slowed down with Mr. D, he
    ular patient as he would have           could have been prevented?” the
                                                                                     of a cantaloupe.”                       might have noted some of the
    liked; but time was money, and he       attorney asked.                                                                  other signs of Fournier’s gan-
    couldn’t afford to waste any.             “Yes,” the expert urologist re-        n’t spend as much time with the         grene, such as pus, odor, or dis-
      One afternoon, Dr. V found a          plied. “Given the severity of the        patient as I should have,” he           coloration, in addition to the
    distraught patient in his exam          swelling and the patient’s comor-        admitted.                               pain and swelling that the patient
    room. Mr. D, 66, was a retired          bidities, he should have been sent         So, Mr. D’s sister, Dr. V, their      reported. It’s important to give
    postal worker with a host of exist-     straight to the hospital for imme-       lawyers, and the mediator spent a       each patient your full attention
    ing conditions, including d
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