KMD16 Posted November 14, 2015 Share Posted November 14, 2015 I recently sent an 8 yo to the ER for abdominal pain, n/v and tactile temp for appendix work up. Pt came to see me 1-2 after he was seen by PCP for similar complaints. Pt was sent home by PCP and treated for viral gastritis. In the ED, the CT abdomen/pelvic demonstrated ruptured appendix. I looked at the PCP visit note and it was so poorly written. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 14, 2015 Share Posted November 14, 2015 Good Job! Link to comment Share on other sites More sharing options...
MT2PA Posted November 14, 2015 Share Posted November 14, 2015 One of my favorite stories, told to me by a patient, was how his doc missed a suspicious result but the PA caught it and insisted on the oncology consult - it was indeed cancer. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted November 15, 2015 Moderator Share Posted November 15, 2015 yup. a pa friend of mine dx colon ca in a pt seen by md pcp x 5 who was told they had hemorrhoids.... Link to comment Share on other sites More sharing options...
LKPAC Posted November 15, 2015 Share Posted November 15, 2015 All of us who have been practicing for a while have stories like this. I always try to remember that it's easier to be the second guy to see a patient, after they don't improve than it was to be the first. Link to comment Share on other sites More sharing options...
Guest Paula Posted November 15, 2015 Share Posted November 15, 2015 I read an article recently that stated the correct diagnosis is missed 20% of the time by physicians. (PA/NP were not include in the study) I can't remember where I read it........probably one of the daily medical news blasts I get from AAPA. Link to comment Share on other sites More sharing options...
KMD16 Posted November 15, 2015 Author Share Posted November 15, 2015 This was a very bad situation. We all had probably missed or overlooked things at some point in our career. But this was really terrible. The MD in question here indicated in her note that patient did complained of abdominal pain and nausea with tactile temperature but never follow through with further specific questions related to abdominal pain complaints. The worst part of this was that in the assessment, the MD never indicated abdominal pain. I was so irritated by this. The poor kid with ruptured appendix that could have been caught if this MD was thorough enough to begins with. Imagine if it was a PA. Link to comment Share on other sites More sharing options...
cbrsmurf Posted November 15, 2015 Share Posted November 15, 2015 All of us who have been practicing for a while have stories like this. I always try to remember that it's easier to be the second guy to see a patient, after they don't improve than it was to be the first. ...and don't forget the difference between an office setting where you have a stethoscope + your fingers vs an ED where you have a lab, CT scan, bedside US, specialty consultants, etc, etc Link to comment Share on other sites More sharing options...
Boatswain2PA Posted November 15, 2015 Share Posted November 15, 2015 There but for the grace of God go I..... Today I had the chance to catch one of my own bouncebacks, and one that I didn't have the "warm fuzzy's" about sending home 5 days ago. KMD - I encourage you to be careful here. Kid could have looked totally different by the time you or the ED doc saw them.On the other hand, 2 nights ago I did an EKG on a lady and pulled an old one from 6 months old ED visit for comparison....old one showed clear-cut convex 3-4mm ST elevation in V1-V3 with reciprocal changes on V6, I and II. The NP that day totally missed it. Guess that could explain the florid CHF she's in now.... Or, the patient I saw tonight with BOTH a small bowel obstruction AND a partial large bowel obstruction who was seen by a PA in a GI clinic 36 hours before and started on hyscociamine. Whoops!! Again, there but for the grace of God go I. (Well....except for the times I've done screwed up!) Link to comment Share on other sites More sharing options...
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