By Stephen C. Morris, MD, MPH | Emergency Medicine Expert Witness

The emergency department is often where the most important early decisions in a patient's care are made. Patients arrive without a diagnosis, frequently with incomplete medical histories, evolving symptoms, and conditions that can range from relatively minor to immediately life-threatening.

For malpractice attorneys evaluating a missed or delayed diagnosis, understanding the realities of Emergency Medicine is therefore critical.

As a Board-Certified Emergency Medicine physician with more than 21 years of active clinical practice, I evaluate these cases from the perspective of a physician who continues to work on the front lines of emergency care.

Emergency Physicians Diagnose the Undifferentiated Patient

Unlike many specialists who see patients after a diagnosis or suspected diagnosis has been established, emergency physicians routinely evaluate what we call the undifferentiated patient.

Chest pain could represent a myocardial infarction—or something less dangerous.

Weakness or dizziness could signal stroke—or another condition entirely.

Fever and fatigue could represent an uncomplicated infection—or evolving sepsis.

Abdominal pain could reflect a relatively benign condition or a surgical emergency.

The emergency physician's responsibility is to identify potentially dangerous conditions, develop an appropriate differential diagnosis, order reasonable testing, interpret the available findings, reassess when necessary, and determine whether the patient should be discharged, admitted, treated emergently, or referred for specialty care.

Those responsibilities frequently become central to medical malpractice litigation.

Avoiding Hindsight in Malpractice Analysis

When reviewing an emergency medicine case, knowing the patient's eventual diagnosis can make earlier symptoms appear more obvious than they actually were.

That is why standard-of-care analysis should reconstruct the clinical situation as it existed when the emergency physician made the decision.

What symptoms were reported?

What were the vital signs?

What did the physical examination reveal?

What risk factors were present?

Were appropriate diagnostic possibilities considered?

Were tests reasonably ordered and interpreted?

Did changes in the patient's condition require reassessment?

Was discharge, admission, consultation, or transfer appropriate?

These questions help determine whether the emergency care met the applicable standard.

Delayed Diagnosis and Causation

Even if an earlier diagnosis should have been made, attorneys must still address causation.

Would earlier diagnosis and treatment probably have changed the outcome?

This is particularly important in time-sensitive emergency conditions such as stroke, myocardial infarction, sepsis, internal hemorrhage, trauma, airway compromise, and other rapidly evolving emergencies.

Emergency physicians understand not only how these conditions present, but how their clinical significance can change over minutes or hours.

Following the Patient Beyond the ER

Emergency Medicine also sits at the intersection of multiple areas of acute care.

A patient's course may begin with EMS, continue through the emergency department, and progress to surgery, anesthesia, intensive care, inpatient medicine, or interfacility transfer.

As an Emergency Medicine Expert Witness, I evaluate that complete acute-care timeline while determining where critical decisions were made and how they may have affected the outcome.

For plaintiff and defense attorneys handling cases involving missed diagnosis, delayed diagnosis, or emergency medical care, an expert who understands the realities of the ER can provide important context to the medical record.

For Emergency Medicine Expert Witness case review, visit www.morrismedicolegal.co