On "Babbage and Kings" and "How sausage was made": and now for the rest of the story

Communication between all involved parties is important for the patient with a complicated medical history. Such interactions amongst physicians was the topic of a Loss Prevention Seminar. The patient was a 24-year-old nurse, a longterm survivor of a childhood cancer. She reported that she had suffered a serious bout of heart failure of unknown etiology. She had barely survived and was just now being allowed to return to work. She recounted that her cardiologist had halted her contraceptive to prevent development of blood clots and had instructed her that she should never become pregnant, because her hear was to weak and show would never survive the pregnancy. The cardiologist had recommended sterilization as being in her best interest. She reported a residual ejection fraction of 20% from cardiac catheterization and echocardiograms. In view of the patient's age and the potential for hemodynamic compromise during surgery, various options were discussed including the long-acting progestational agent, Norplant. This would pose no cardiac risk and would be easily reversed. She agreed to this alternative provided the plan was acceptable to the cardiologist. A series of correspondences was found between her cardiologist and the cancer clinic regarding the initial hospitalization for the heart condition. The record also contained a letter from a second cardiologist who corroborated the patient's story. Then the referring cardiologist was contacted and gave a much different assessment of the situation. The cardiologist reported that the patient had indeed suffered a severe case of viral endocarditis. He had discontinued her oral contraceptives and had told her that she should not get pregnant until after she had made a significant recovery. He had never recommended sterilization. In fact, he had seen her recently and informed her that she had made excellent recovery thus far. He agreed that Norplant was a good choice of contraception for her.