High Blood Pressure and Stroke: Medical Malpractice?

When I go to a fine restaurant, I expect a pleasing experience. I expect little variation from perfection in the quality of the food, atmosphere, and service. If my expectations are not met, I can simply decide not to return.

When I go to a fast-food restaurant, I expect my order to be completed, and to receive reasonable, polite service. If my expectations are not met, I can simply decide not to return. How does this differ from a visit to the emergency department?

It is the emergency department’s obligation to provide patients with the service they need, whether or not that is the service they want.

Neither the fine dining restaurant nor McDonald’s will try to talk you out of a high-salt, high fat and nutritionally deficient meal. They will both be happy to serve you. It doesn’t matter if you’re a heart patient and want all the cholesterol you can eat, or if you’re a diabetic and want to consume a few hundred grams of sugar in your Coke with your processed, fried potatoes.

Some patients want to have what they want, and often don’t want to hear what they need. This can possibly lead to medical malpractice.

Patients in pain often want pain relief; they often can’t focus on the underlying problem of what is causing the pain. Our obligation is to treat the underlying cause and try to convince the patient the underlying condition seriously requires urgent attention. Some patients don’t want to hear it.

On my last shift, one such patient who had a headache with high blood pressure, exclaimed, “Doc, every time I come to the ER with one of these headaches, you guys treat my pressure and discharge me.”

I asked, “And do you follow up and take your medications?”

He said, “Every time I take my medications, they don’t work, so I don’t take them.” Why would you expect your blood pressure to be controlled without taking medication?

Fast-forward to a potential scenario month from now. Consider the same patient, same headache, but with different symptoms. Now he has blood leaking from a blood vessel inside his brain.

Blood compressing his brain from a cerebrovascular accident (stroke) is caused by uncontrolled high blood pressure. He is unable to speak, unable to move half his body, doomed to a life in a long-term care facility, incontinent of bowels, drooling … well, let’s say, “unpleasant” is an understatement.

Fast-forward again, months later. The family seeks an attorney to investigate the circumstances of that first emergency room visit. The family and the attorney representing the patient (now called plaintiff) want to know why he wasn’t admitted to the hospital the day he explained he did not take his medications. Why didn’t someone ensure he took his medications? We don’t admit patients so they can be handed pills to swallow.

Is this an example of emergency medical malpractice? Was there an error committed by the doctors or nurses?

No, not in this instance. The patient is responsible for following the instructions of his physician. His devastating injuries could be avoided had he followed up and taken his medication. A couple of pills a day, that’s all; that’s everything that would be required. But the pills have to go down the throat, not sit in the pharmacy bottle.

Dean Dobkin, M.D. was a practicing emergency physician at the Philadelphia Veterans Affairs Medical Center. A graduate of Albany Medical College in 1976, Dr. Dobkin completed residency training in Emergency Medicine at the University of Illinois while the specialty was in its infancy. He has been certified and recertified three times, as a specialist in Emergency Medicine by the American Board of Emergency Medicine.

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