I never comment on the work up by any doctor prior to my involvement. Hindsight is always 20/20 and playing the armchair quarterback is always very easy once all the information is in front of you.

But to your point, the pt saw his primary doctor once and decided to bypass him after he wasn't getting better. So from the primary doctor's viewpoint he had no idea that the patient wasn't improving. More to that point, the primary doctor had no idea what the guy had until I called him on discharge. So again, easy to blame someone once you have all the info but I always put myself in someone else's shoes before assigning blame.