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communication led to a patient suffering serious complications that
could have been easily avoided with a properly followed protocol for
hematology clearance.
A note in the margin
In one of my current cases, a woman went to a hematologist in
2008 to confirm a condition she had been diagnosed with as a child,
von Willebrand disease, a hereditary coagulation abnormality that
can cause extended or excessive bleeding, especially with major
surgery. The hematologist ran some tests that were improperly
interpreted and hand-wrote a short note in the margin of a flow
sheet (not a regular consultation or progress note) stating that she
didn't believe that the patient had the disease. However, in a later
note she recommended follow-up testing, though the patient never
returned.
Fast-forward 2 years. The patient was suffering neck and arm pain
and underwent an MRI, which showed a Chiari malformation.
Because of the known history of von Willebrand disease, the neuro-
surgeon — preparing for the major decompression surgery — as well
as the hospital and anesthesia provider, asked the patient to retrieve
her records from her hematologist.
After several unsuccessful attempts at getting the records from the
hematologist, the patient finally obtained some copies of these hema-
tology records from another physician and sent them to the hospital.
The hospital and doctors did not directly contact the hematologist for
any information and decided that these second-hand records, contain-
ing the note written on the margin of a flow sheet, were satisfactory.
Consequently, the patient did not have a pre-op evaluation or consul-
tation regarding her known history of von Willebrand disease.
M E D I C A L M A L P R A C T I C E
