Dangers of Assumptions in Medical Malpractice Case Reviews
Are you making unwarranted assumptions when you review cases?
I walked into the supermarket right after taking my kayak on a 5-mile trip on a local river. There was a stiff headwind that day, and it took more effort than usual. After ringing up my order, the clerk asked me if I needed help to my car. I said, “No, I’m fine, thank you.” She replied, “Are you sure?”
What flashed through my mind was “Don’t make assumptions about me because I have grey hair.” I politely said, “I just kayaked 5 miles. I think I can make it to my car.”
When a pro se plaintiff called me recently to ask if I’d help her with her medical malpractice case, I replied that it was against the ethical codes of LNCs to work directly with plaintiffs who do not have an attorney. Then, I offered the opinion that it can be difficult for a pro se plaintiff to win a case without a lawyer. She snapped back, “I am doing just fine without a lawyer. It is obvious you know nothing about medical malpractice.” She hung up on me before I could reply.
If you think I know nothing about medical malpractice, read my bio at the end of this blog.
Both of these ladies made unwarranted assumptions about me. When attorneys send a medical malpractice case to a legal nurse consultant for review, they are often looking for answers.
- Was there a breach in the standard of care?
- Did the healthcare providers make mistakes?
- Is there enough evidence to support litigation?
It can be tempting to form an opinion quickly, especially when the facts appear obvious at first glance.
- A patient suffered a devastating injury.
- The diagnosis was delayed.
- A medication error occurred.
- A poor outcome followed treatment.
Yet one of the most important disciplines in medical malpractice case analysis is resisting the urge to make assumptions.
Assumptions can lead to inaccurate conclusions, overlooked evidence, and recommendations that ultimately damage a case. The strongest case reviews are built on facts, documentation, timelines, and objective analysis—not on impressions.
The Medical Record Rarely Tells the Entire Story at First Glance
Medical records are often incomplete, disorganized, and sometimes contradictory.
Your initial review may suggest that a physician ignored symptoms or failed to respond appropriately. However, additional records may reveal consultations, phone calls, diagnostic test results, or clinical observations that provide a different perspective.
Poor Outcomes Do Not Automatically Mean Negligence
Medicine is not an exact science. Patients can experience complications even when healthcare providers follow accepted standards of care.
- A patient may die despite prompt treatment.
- A surgical complication may occur despite a technically successful procedure.
- An infection may develop despite appropriate preventive measures.
You must separate your emotional reactions to the outcome from the objective analysis of the care provided.
The central question is not whether the outcome was unfortunate. The question is whether the healthcare providers acted reasonably and consistently with accepted standards under the circumstances that existed at the time.
Avoid Hindsight Bias
Hindsight bias is one of the greatest threats to objective case review. When reviewing records months or years after an event, the reviewer knows the outcome. The healthcare providers did not.
Place yourself in the position of the healthcare providers at that specific moment and evaluate what information was available at the time they made their decisions.
Looking backward, it may seem obvious that the diagnosis should have been made immediately.
However, at the time of presentation, the patient may have exhibited symptoms that were consistent with several more common conditions.
Documentation Gaps Are Not Always Evidence of Negligence
“If you didn’t chart it, you didn’t do it.” But wait! Is this true? Another dangerous assumption is believing that every missing piece of documentation represents negligent care.
While incomplete charting can create problems, absence of documentation does not automatically prove absence of care.
Healthcare providers sometimes perform assessments or interventions that are not documented thoroughly.
This does not excuse poor documentation, but it does mean that you should be careful in drawing your conclusions. Dr. Mariann Cosby wrote an excellent chapter on this very topic in Medical Record Analysis Volume 3.
Search the medical record and other documents for additional evidence, which may exist in:
- Medication administration records
- Monitor strips
- Laboratory records
- Electronic audit trails
- Incident reports
- Witness testimony
- Policies and procedures
A complete investigation requires examining all available sources of information.
Verify Every Timeline and don’t Make Assumptions
A reviewer may believe a physician delayed responding to a critical laboratory result. However, closer examination may reveal:
- The laboratory delayed reporting the result.
- The result was entered incorrectly.
- The physician was notified promptly.
- The documented time was inaccurate.
Timelines often expose facts that challenge initial impressions. Creating a detailed chronology helps eliminate guesswork and reveals what actually occurred.
Be Careful with Expert Opinions
Experts play a significant role in medical malpractice litigation. However, legal nurse consultants should avoid assuming that their client’s expert witness’s opinion is automatically correct.
An expert may identify a potential breach of care. Evaluate that opinion against the records, clinical guidelines, literature, and applicable standards.
The strongest case analyses are supported by evidence rather than reliance on authority alone.
Questions to ask include:
- What facts support the opinion?
- Are there alternative interpretations?
- Is the expert’s opinion consistent with the documentation?
- Are there recognized standards supporting the conclusion?
Use your critical thinking to question the expert’s opinions, regardless of the expert’s credentials.
Look for What Is Missing
Many reviewers focus on the information in the records. Experienced analysts also pay attention to what is absent.
Here’s where AI falls down in summarizing medical records. You know that the record may be incomplete. Missing physician notes, undocumented assessments, unexplained delays, absent informed consent forms, or incomplete communication records may reveal areas requiring further investigation.
At the same time, missing information should trigger questions rather than assumptions.
Instead of concluding that negligence occurred, ask:
- Why is this information missing?
- Could it exist elsewhere?
- Is there another explanation?
Your curiosity leads to pinpointing what is missing, resulting in a stronger analysis than speculation.
Objectivity is Your Greatest Asset
Legal nurse consultants provide value because they bring clinical knowledge and objective evaluation to complex medical cases.
Attorneys rely on consultants to identify strengths, weaknesses, unanswered questions, and areas requiring additional investigation.
The moment a reviewer begins making assumptions, objectivity is at risk.
The most effective reviewers approach each case with an open mind. They gather facts, verify timelines, examine documentation carefully, and challenge their own conclusions before presenting findings.
A medical malpractice case may appear straightforward at first glance. Yet many cases change significantly as the attorney obtains additional records, you create timelines, and analyze evidence.
The strongest opinions are not built on assumptions. They are built on careful examination of the facts. That discipline protects the integrity of the review process and helps attorneys make informed decisions about the merits of a case rather than rely on assumptions.
Pat Iyer MSN RN LNCC is president of The Pat Iyer Group. She has almost forty years of experience developing resources to assist LNCs in obtaining more clients, making more money, and achieving their business goals and dreams.
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