Telephone triage is an inextricable component of health care today. Telephone medicine accounts for more than a quarter of all patient care, according to an Oct. 1, 2002 AAP News article (bit.ly/AAPphonetriage). Lawsuits involving telephone triage tend to allege failure in a physician’s duty to treat, abandonment of the patient, or provision of sub-standard care. Take the following two cases:
Case 1. A 15-year-old boy with history of ureteropelvic junction obstruction complains to his mother that he has pain with urination. The mother calls the urology clinic and speaks to a nurse, who encourages the patient to come in and provide a urine sample. A sample is collected and sent, and the physician places the boy on trimethoprim-sulfamethoxazole (Bactrim) for a week while the results are pending.
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On day 2, the mother calls the urology clinic again and speaks to a nurse. Her son is feeling worse, with a low-grade fever and some nausea and vomiting. The nurse opines that the antibiotics need more time to “kick in” and does not report this call to the physician. On day 3, the mother calls with the same complaints and a nurse provides a similar response, that the antibiotics need more time. A physician is not notified of this call.
On day 4, the patient has an acute abdomen and is transferred to the hospital where he is diagnosed with a perforated appendix. He spends 8 days in the hospital and then is sent home with a peripherally inserted central catheter line for antibiotics. In the course of treatment, he develops hearing loss and vestibular damage from gentamicin (Garamycin). The urologist is sued for a failure to diagnose appendicitis.