SEATTLE—At the core of medical and of public health training, we learn that you cannot just look narrowly at the problem in front of you, you are obliged to look for the systemic causes, how did the patient get into this state and what are the challenges going forward? Failing to do so is malpractice.
If an internist were to see a patient who is elderly and very overweight, and who came in complaining of a sore on her foot, one that wasn’t healing, and that internist merely prescribed an ointment and failed to address the very real likelihood that this patient has vascular disease and diabetes, and was in grave danger of gangrene and amputation, in that case an objective party would review this failure as medical malpractice.