A single handwritten letter on a prescription — “N” for normal — became the pivot of a medical negligence case, after a patient later underwent major heart surgery. The Consumer Commission held that when cardiac risk factors are present, a general practitioner cannot rely on their own interpretation of an ECG without seeking specialist input.

The patient had been under treatment for hypertension and diabetes for several years. He consulted a general practitioner regularly and was advised investigations from time to time. Despite being told earlier to undergo further cardiac evaluation, he remained irregular with follow-ups and medication.

When he later developed chest pain and breathlessness, he returned to the same doctor and was advised an ECG. The ECG was marked as “normal,” and no referral to a cardiologist was made. The patient continued on the same line of treatment.

Months later, after a severe episode of chest pain, he consulted a cardiologist elsewhere. Further investigations revealed advanced coronary artery disease, with complete blockages in all major arteries. He eventually underwent bypass surgery.

The patient approached the consumer forum, alleging that the earlier doctor had failed to recognise warning signs and had wrongly interpreted the ECG, delaying specialist care.

The doctor defended the treatment, pointing to the patient’s long history of diabetes, irregular medication, and failure to follow earlier advice to consult a cardiologist. It was argued that the deterioration was a result of the patient’s own non-compliance, not medical negligence.

The Commission, however, relied on expert cardiology opinion placed on record. The expert reviewed the ECG and concluded that it was suggestive of anteroseptal ischemia, not a normal tracing. The Commission noted that the doctor had neither challenged this expert opinion nor explained why a cardiology referral was unnecessary despite the patient’s risk profile.

The finding was clear: while a general practitioner may order an ECG, interpreting it conclusively in a high-risk cardiac patient without specialist consultation fell below the expected standard of care. The Commission upheld the finding of deficiency in service and affirmed the compensation awarded, while rejecting the plea for enhancement.

IML Insight

This case reinforces a critical boundary in clinical responsibility. Primary care doctors are not faulted for ordering basic tests — but they are expected to recognise when interpretation exceeds their scope. In patients with cardiac risk factors, an ECG is not a formality. When in doubt, courts expect a referral, not reassurance.

Source : Order pronounced by Madhya Pradesh State Consumer Disputes Redressal Commission on 30th October, 202