MEDICAL MALPRACTICE LAWSUITS MAY BE BROUGHT AGAINST
PRIMARY CARE PHYSICIANS, EMERGENCY DEPARTMENT PHYSICIANS
AND CARDIOLOGISTS BASED ON THE FAILURE TO DIAGNOSE CORONARY
ARTERY DISEASE ¤CAD¥, ARRHYTHMIA OR OTHER MANIFESTATIONS
OF HEART DISEASE. THIS RISK MAY BE DIMINISHED IF THERE IS AN
INCREASED AWARENESS AND UNDERSTANDING BY PHYSICIANS AND
PATIENTS THAT MEN AND WOMEN MAY DEMONSTRATE SUBSTANTIALLY
DIFFERENT MANIFESTATIONS OF HEART DISEASE.
THIS IS IMPORTANT because studies have
shown that women are significantly more
likely to receive a misdiagnosis of ischemia
or even myocardial infarction
1
, which may
culminate in legal exposure.
A physician-owned medical malpractice
insurer reviewed claims from 2011 to 2015
involving undiagnosed heart disease in
women to assess for potential trends of
increased exposure. The study found a
significant sample died from an incorrectly
diagnosed heart condition and 28°percent
had heart muscle damage from myocar-
dial infarction
2
.
Medical outcomes highlighted in mal-
practice lawsuits demonstrate occasional
lack of appreciation about the extent to
which women are plagued by heart disease
but do not present with classic symptoms.
Insu¥cient patient and physician aware-
ness is further evident based on statistics
and observations. Only one in five women
believe that heart disease is their greatest
health threat. Yet one in three women die
of heart disease each year, while one in 31
die from breast cancer
3
. Many patients
repor t t hat t hei r physicia n s neit her
discuss coronar y and arrhy thmia risk
nor recognize the symptoms, "mistaking
[the symptoms] instead for signs of panic
disorder, stress and even hypochondria
4
."
The following clinica l obser vations
highlight similarities and dierences in
the presentation of cardiac symptoms in
men and women that can be emphasized
to improve diagnosis in all patients — but
especially women. Both genders may be
a ffected by risk factors such as obesit y,
smoking, diabetes, high blood pressure,
fa mily histor y, metabolic syndrome a nd
high levels of c-reactive protein. Men
a nd women may a lso experience classic
sy mptoms, such a s chest pa in, but "…
women a re much more likely to [ have]
less common symptoms such as indiges-
tion, shor tness of breath a nd back pa in,
sometimes even in the absence of obvious
chest discomfor t
5
."
Wo m e n a r e d i s p r o p o r t i o n a t e l y
a f fec t ed by h i g h t es t os t erone level s
prior to menopause a nd hy per tension
during menopause. Women ca n be more
common ly a f fected by stress, depres-
sion or autoimmune disea ses, such a s
rheumatoid ar thritis, which can fur ther
impact ca rdiac risk
6
. O vera l l, women
develop ca rdiovascula r disease seven to
10 years later than men
7
, and clot-busting
drugs a nd other medica l procedures a re
not necessa rily as effective for women
8
.
A greater awareness of the aforemen-
t ioned r i sk fa ct ors may i mprove t he
diag nosis of hea r t disease. Physicia ns
may further reduce associated medica l
malpractice risk by documenting all dis-
cussions regarding symptomology, testing
and recommendations. More specifically,
it can be beneficia l to document whether
recommendations made were followed
and to what extent. Patients can a lso be
counseled about addressing risk factors,
such as smoking, diet, exercise and stress,
that are more easily controlled. The devel-
opment of written chest-pain protocols
may a lso be adva ntageous. Physicia ns
should oer same-day appointments or
consider sending patients to a n emer-
gency department when they complain
of continued symptoms.
All of these measures should always be
documented in a patient's medical record so
they can be substantiated, and successfully
defended, during a trial.
Peter T. Crean is a Senior Trial Partner
with more than 30 years of legal experi-
ence. His practice encompasses all aspects
of medical malpractice and professional
liability defense. Michelle A. Frankel is an
Associate at Martin Clearwater & Bell'LLP,
where she focuses her practice on the defense
of medical malpractice cases. For more
information, visit mcblaw.com. ■
1. erlegal.com/doctors-failing-diagnose-heart-
attacks-women/
2.
t h e d o c t o r s . c o m / K n o w l e d g e C e n t e r/
PatientSafety/articlesTaking-the-Risks-to-
Heart-Misdiagnosis-of-Heart-Diseasethe-
heartfoundtion.org/heart-disease-facts/
heart-disease-statistics/
3.
health.harvard.edu/heart-health/gender-
matters-heart-disease-risk-in-women
4.
hopkinsmedicine.org/heart_vascular_insti-
tute/clinical _services/centers_excellence/
womens _cardiovascular_health _center/
p a t i e n t _ i nfo r m a t i o n / h e a lth _ t o p i c s /
heart_disease_gender_di˜erences.html
5. Ibid.
6.
n c b i . n l m . n i h . g o v / p m c / a r t i c l e s /
PMC3018605/
7.
health.harvard.edu/heart-health/gender-
matters-heart-disease-risk-in-women
Gender-specific Cardiac Risk
May Impact Medical Malpractice Liability
BY PETER T. CREAN AND MICHELLE A. FRANKEL
SPECIAL
CLINICAL
SECTION:
CARDIOLOGY
1 8
