> I don't think it's nearly as dire as that (but I'm not a medical professional).

Then you don't know how wetting-themselves-terrified most physicians are of malpractice. It builds itself into how people practice on a daily basis. I'm considered relatively "bold" among my peers in my inclination to practice what I think best serves my patients rather than covering my ass, and even I'm reading this as "if I lived in MN, I'd be leaving MN."

> Maybe this lawsuit shouldn't have gone this way, and the NP apparently shouldn't have tried to avoid sending the patient to the ER, but it seems to me the takeaway is a doctor shouldn't make a firm admit/non-admit decision based on partial lab results.

It's just an irrelevant discussion. It's like blaming the janitors for making a non-admit decision. Emergency care goes through the ED, period, no "decision" is involved in the process.

>and point the NP to the ER otherwise. Also point out that if the patient in this case really did have a serious infection, avoiding the ER would be bad and slow down essential treatment anyway, and it would actually harm the patient for a non-ER doc to admit them.

It's really not a doc's place to explain to people "how ER's work," and "basic clinical reasoning" (how and when to escalate care is clinical reasoning. It's a big part of what med students learn in the second half of med school.) If you explain that to people, you quickly become the massive asshole doc that people talk shit about behind their back. If you do it to an NP, all the nurses will be trying to eat your liver. As it is, he was only one of two docs that day to explain to her that diabetic episodes cause white counts, so he was already going to be having a tense exchange in which she didn't know basic internal medicine and was having it explained to her by "an arrogant doctor." Traditionally, responsibility for basic clinical reasoning sits solely with the physician in charge of making the call. If NPs want to practice like physicians, they can join us in taking full responsibility for the decisions they make.

> Everyone agrees that there are lots of subtle things about a patient which a medical professional can pick up on that are not clearly shown in lab results, right? Wouldn't it have been obvious from the described phone conversation that the nurse's spidey senses were telling them something?

I want to be clear again: she is practicing independently. She's not a subordinate reporting information that he is failing to take seriously enough. She is, theoretically, a colleague getting a curbside. She gets his opinion, and she can do with it what she wants. That's how consults work in all of medicine.

Second, a conversation that opens with "doesn't understand how the ER works," and "doesn't understand white counts in diabetes" (I really can't stress how absolutely fundamental, medicine 101 this is), doesn't lead to you thinking "Gosh, I must be missing something, because she seems concerned." It leads to you thinking, "This person is a fucking moron."

> I think there's plenty of blame to heap on the clinic, too. Does anyone think the NP, after questioning the decision of both docs, just casually decided not to send the patient to the ER?

I don't know if it was casual or not, but since it was completely her call whether or not to do it, apparently "yes."

> The calculus was almost certainly: "two doctors told me I'm wrong, so I don't have much personal liability here, and there may be negative career consequences if I send this patient to the ER and I'm wrong."

You don't have negative career consequences for sending patients to the ED anywhere I've seen. It's the universal CYA: worst case scenario, send them to the ED, you can't be blamed. And of course she still has personal liability: she's the clinician making the call (which is why she got sued and promptly settled). If 30 doctors who aren't in charge of her tell her she's wrong, it doesn't matter. The docs who shot her down weren't in charge of her. They were just opinions, and don't shield her from anything.

(That said, a third doc has reviewed the medical records - granted, for the defense - and justified the call the first two docs made. I'd point out the criticisms of the suitor's expert witness, but they don't have one.)