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When patients are negligent

Posted Nov 18 2008 12:17am

I just saw a memorable patient. The couple had been trying to conceive for over 7 years, and she was now 35. She had missed her period and had had a positive home urine pregnancy test. She wanted to confirm her pregnancy was healthy, which is why she came to me. Her blood test for beta HCG showed a level of 2000 mIU/ml, confirming she was pregnant, but I could not see a pregnancy sac inside the uterine cavity on vaginal ultrasound scanning. This meant she had an ectopic pregnancy, a condition in which the pregnancy lodges in the fallopian tube, instead of the uterus. This can be a life-threatening problem if the pregnancy is allowed to grow inside the tube, as it can rupture, and cause massive internal bleeding. I congratulated myself on making the diagnosis so early, and told her that we needed to kill the pregnancy; and that we could do it safely and easily with an injection of methotrexate, an anti-cancer drug which kills the rapidly dividing cells of the embryo, so that it gets reabsorbed by the body, without having to do any surgery. I thought they would be pleased that I had such an effective and simple solution to what could become a major problem - and which used to be one of the biggest killers of young women in the past. Much to my surprise, her husband flatly refused to believe me ! " But her home urine pregnancy test is positive, and I am sure she will have a baby !" was his refrain. He wanted a baby so badly that he was in denial mode - the last thing she wanted to hear was bad news. I suggested that they get a second opinion, and that she seek urgent medical attention before things got out of hand.
She left the clinic, and never followed up. I was very worried about her, since she was a "walking time bomb", and called her up 2 days later to find out what she had decided to do, but her husband was unwilling to take my call !
I learnt later from a colleague that her husband adamantly refused to take her to another doctor. 3 weeks later she had severe abdominal pain because of a ruptured ectopic pregnancy , and finally ended up having emergency surgery to save her life.
Everyone makes such a hue and cry when doctors are negligent. What happens when patients are negligent ? Who is responsible then ?

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