He looked angry before he even sat down, which was a mistake. Boards tend to be more forgiving of contrition than contempt, and he radiated the latter. Under questioning by his own attorney, he sounded controlled. He had relied on his fifteen years of emergency medicine experience. He had used his best clinical judgment under the circumstances. Not every abdominal pain patient warranted imaging. Emergency medicine required rapid triage and risk stratification. Hindsight bias could make any adverse outcome look obvious after the fact.
All predictable. All rehearsed.
Then the board’s attorney began cross-examination.
“Dr. Vance,” she said, “your physical exam note describes mild tenderness on palpation. Three nurses documented severe distress and difficulty lying flat due to pain. How do you explain the discrepancy?”
Vance shifted. “Patients often exaggerate. Part of clinical judgment is distinguishing subjective complaints from objective findings.”
“So your position is that the nurses were mistaken?”
“My position is that I relied on my own exam.”
“An exam nursing documentation suggests lasted approximately ninety seconds. Is that accurate?”
“I performed an adequate examination.”