Opinion ID: 894850
Heading Depth: 1
Heading Rank: 4

Heading: Do Physicians As Patients Have a Different Duty?

Text: The primary dispute between the parties in this appeal is whether Axelrad's medical training should be taken into account in evaluating the history he gave. Axelrad did not object to the admission of such evidence; indeed he offered most of it himself. But he argues it cannot be considered in evaluating legal sufficiency because a physician as patient should not be required to exercise any heightened degree of care above that of an ordinary person. This argument represents a misunderstanding of the nature of the physician-of-ordinary-prudence standard. It is not a higher standard of care (like strict liability, or the high-degree-of-care standard for common carriers [16] ) or a lower standard of care (like gross negligence, or the willful-and-wanton standard for emergency care [17] ). It is instead the ordinary-care standard, modified to instruct jurors that under the same or similar circumstances means they must consider a physician's training. We said so in Hood v. Phillips, our seminal case defining a physician's standard of care: The burden of proof is on the patient-plaintiff to establish that the physician-defendant has undertaken a mode or form of treatment which a reasonable and prudent member of the medical profession would not have undertaken under the same or similar circumstances. The circumstances to be considered include, but are not limited to, the expertise of and means available to the physician-defendant, the health of the patient, and the state of medical knowledge. Unless the mode or form of treatment is a matter of common knowledge or is within the experience of the layman, expert testimony will be required to meet this burden of proof. . . . Although the trial court refused to submit an issue regarding ordinary negligence, [the] evidence would raise a question of fact for the jury on the issue of ordinary negligence and such issue should have been submitted. [18] The same point is made by the Restatement. Both the First and Second Restatements of Torts summarize the traditional reasonable-person standard as one taking into account both the knowledge and skills of an ordinary person and such superior attention, perception, memory, knowledge, intelligence, and judgment as the actor himself has. [19] Both Restatements include an illustration specifically applying this standard to physicians, even when they are not acting in that capacity: A is a physician. His child exhibits symptoms which A, because of his previous training and experience, should recognize as indicating that the child has scarlet fever. A fails to recognize them, and permits his child to go to school, where the child communicates the disease to B, another pupil. A is negligent in not recognizing the risk, although if he were a layman he might not be negligent. [20] This principle  that ordinary prudence under the same or similar circumstances includes a party's expertise  is not limited to physicians. As Prosser and Keeton note, it applies to many other skills: [I]f a person in fact has knowledge, skill, or even intelligence superior to that of the ordinary person, the law will demand of that person conduct consistent with it. Experienced milk haulers, hockey coaches, expert skiers, construction inspectors, and doctors must all use care which is reasonable in light of their superior learning and experience, and any special skills, knowledge or training they may personally have over and above what is normally possessed by persons in the field. [21] In the expert skiers case Prosser and Keeton mention, the federal Tenth Circuit noted that an expert-of-ordinary-prudence is merely an application of the reasonable-person standard, not a different one: It would appear then that in order to satisfy the standard of care, a person having special knowledge must exercise a quantum of care which is commensurate with the circumstances, one of which is his or her special skill and training. An instruction of this kind is not easy to expound in a charge to a jury for the reason that it is capable of creating the impression that a double standard of care exists. In truth there is but one standard, that of reasonable prudence under the circumstances. The decision must be made on the basis of the surrounding circumstances, including the fact that the person involved is an expert. [22] We have never applied the physician-of-ordinary-prudence standard to a plaintiff's negligence, but then we have never addressed a medical malpractice claim by a physician. Nor does it appear that any case addressing a patient's failure to give an accurate medical history has ever done so. [23] But generally [t]he rules which determine the contributory negligence of a plaintiff are . . . the same as those which determine the negligence of the defendant. [24] As jurors analyzing the same or similar circumstances must consider a physician's special knowledge when a doctor is the defendant, it is hard to see why they should not do so when a doctor is the plaintiff. Axelrad makes the same mistake in arguing that the charge held Jackson to the standard of a prudent physician, but Axelrad to the standard of a prudent person. The jury questions included a physician-of-ordinary-prudence charge as to Dr. Jackson and a person-of-ordinary-prudence charge as to Axelrad. As there was no objection, legal sufficiency must be examined by this charge. [25] But for the reasons already discussed, a charge asking whether Axelrad exhibited ordinary prudence under the same or similar circumstances at least allowed jurors to consider his training, even if it did not instruct them to do so. In its expert-skier case, the Tenth Circuit held a person-of-ordinary-prudence charge was not prejudicial on just this basis. [26] While a charge that prohibited jurors from considering Axelrad's special knowledge might require a different result, [27] this charge did not. Here, jurors could hardly have overlooked Axelrad's special knowledge, as he emphasized it throughout the trial. Axelrad designated himself as a testifying expert, and gave several expert opinions to the jury. In the first minute he was on the stand, he opined that Dr. Jackson was a bad doctor, explaining that I felt compelled to bring this lawsuit against him . . . because he's not a good doctor. Axelrad emphasized to the jury that he had passed judgment on other doctors as a member of state medical boards in both California and Texas. He estimated giving more than 150 depositions as an expert in medical negligence cases. While his practice was limited to psychiatry, he denied any unfamiliarity with abdominal complaints, arguing that during his four years as an emergency room physician he had a lot of opportunities to examine abdomens. Having presented himself to jurors as a person with superior knowledge, he cannot complain that jurors might have taken him at his word. Moreover, Axelrad insisted he had reported that his pain originated in the left lower quadrant, which he acknowledged was a classic sign of diverticulitis. As defense counsel put it with some embellishment in his opening argument, our grandmothers could all diagnose diverticulitis if you came in and said, `I have left lower quadrant pain.' Taking this position strengthened Axelrad's case against Dr. Jackson if jurors credited it. But if they did not, it strengthened an inference that he failed to exercise ordinary care when he failed to mention it. The court of appeals pointed out that Axelrad never admitted knowing the significance of where his abdominal pain started. [28] But of course litigants rarely admit negligence on their own part. The question here is whether there was evidence from which reasonable jurors could infer Axelrad either knew or should have known he needed to report this information. [29] The court of appeals also found it implausible that a sick patient would fail to report a significant symptom, [30] but it is no more implausible than that a doctor would fail to avoid harming a patient and getting sued. The defense presented evidence that haste and impatience sometimes caused Axelrad to downplay his symptoms, fail to follow doctors' orders, and testify to checkups that in fact never occurred. Whether plaintiffs or defendants, people sometimes make mistakes, and it is generally up to the jury to decide who did. [31] Again, there will be cases in which a patient is a doctor with no special knowledge of a particular disease, or so sick as to be unable to use it. But whether either was the case here was hotly disputed. While Dr. Jackson asked only general questions about Axelrad's condition (Tell me exactly what is going on), we cannot say he was required to ask a fellow physician the same questions he would ask everyone else. Similarly, while most patients might not be expected to volunteer where the pain began, we cannot say Axelrad was not required to say something more. As there was evidence from which jurors could have found both doctor and patient were at fault in diagnosing this situation, we hold the court of appeals erred in disregarding one part of the jury's verdict.