What a primary care review usually focuses on

Diagnosis, referral, medication, and follow-up. A case review should reconstruct the sequence of history and exam, differential diagnosis, screening, referral, and follow-up of abnormal results from the records available at each decision point.

Five decision points to map

  • 1. History and exam
  • 2. Differential diagnosis
  • 3. Screening
  • 4. Referral
  • 5. Follow-up of abnormal results

Records that can answer those questions

  • Primary Care consultation, procedure, or encounter notes
  • Orders and test results used to make the clinical decision
  • Medication, monitoring, procedure, or nursing records tied to the event
  • Communication with the patient and other specialties
  • Later treatment showing the complication, corrected diagnosis, or outcome

Expert and causation questions

  • What training and specialty should the reviewing primary care expert have under state law?
  • Which of the key decision points in diagnosis, referral, medication, and follow-up is actually being challenged?
  • What information was available at that time, not only in hindsight?
  • What part of the later harm is attributable to the underlying illness or known risk?
  • Would a different medical decision probably have changed treatment or outcome?

Related specialties

Use licensing, records, and medical-information sources appropriate to the specialty.