Description
Discussion Prompt
A patient dies from a pulmonary embolism after seeing a clinician who did not believe that the situation had been that urgent.
Esteban was a 42-year-old nurse practitioner working for a small practice that included his
supervising physician, Dr Stew. Esteban had been working at the practice for close to a decade. He and his supervisor, Dr Stew had a good working relationship. When Esteban started at the practice, Dr Stew had been very careful to go over his patients’ charts with him, to make suggestions when necessary, and to follow up on more intricate cases. As the years passed, however, his involvement with his day-to-day work gradually decreased, until he rarely looked at his patients’ charts and they only discussed things if there was a particular question. Esteban worked mostly independently. Most of his patients made appointments directly to see him.
One of Esteban’s patients was Mr. Shien, a 55-year-old man with a history of gout. Mr. Shien was an anxious patient. Every new pain caused him great worry and concern, and he frequently feared the worst. One afternoon Mr. Shien came into the office complaining of a flare-up of his gout. The patient described his pain with great animation and concern. After a brief exam, Esteban prescribed prednisone and gave the patient a dexamethasone injection.
The patient left but returned 3 weeks later. “My left calf is all swollen,” he told the clinician. “It hurts behind my knee. I can barely limp around! Do you think this is serious? Do I need an X-ray or something?” Mr. Shien’s anxiety was palpable.
Esteban measured the patients’ left calf, which was 44 cm. The patients’ right calf measured 40.5 cm. Esteban considered the situation. He knew that deep vein thrombosis (DVT) was a possible cause of swelling and pain, but he doubted this was the case and he noted this in the patients’ file. Instead, he stated in the file that he believed the pain was due to the patients’ gout, Baker’s cyst, or radiculopathy. “I don’t think this is anything to be worried about,” he told the patient in what he hoped was a calming voice. “I’m going to give you another dexamethasone injection in your left ankle. If your calf continues to swell, then I will order an ultrasound so we can get a better idea of what is going on.” He did not mention to the patient that the purpose of the ultrasound was to rule out Deep Vein thrombosis, nor did he explain to the patient what a DVT was to not alarm him more than necessary.
The patient went home but called the office later that day complaining of increased swelling and pain in his left calf and knee area. Esteban ordered an ultrasound to be performed the next day. The following day, after the ultrasound was performed, the results were called into Esteban’s office, and they revealed that the patient did have a DVT. The patient was called and told to come to Esteban’s office for an evaluation. When he arrived, Esteban measured his left calf and it was larger than it had been the previous day, so Esteban advised him to go right to the emergency department immediately.
Mr. Shien and his wife rushed to the emergency department, but shortly after arriving there the patient underwent cardiac arrest. Resuscitation efforts were unsuccessful, and the patient was declared dead. An autopsy revealed a pulmonary embolism. Esteban was shocked when he heard about Mr. Shien’s passing. He had not believed that the patient’s situation had been that urgent. He felt terrible about the patient’s death, and that feeling was only compounded when he received notice that both he and the practice he worked for were being sued for medical malpractice by the patient’s widow.
Esteban met with the defense attorney provided by his malpractice insurance. The attorney had the patient’s records reviewed by his own medical experts. After the experts expressed some criticism about how Esteban handled the case, the attorney advised settling, but a settlement could not be worked out and the case proceeded to trial.
In this week’s readings, you will be reviewing the caring of the advance practice nurse and the art and diagnosis of treatment. Often, we focus on management, but it is important for you to understand the legal implications, as well as you living with the choices that you decide to or not make. Answer all of the questions below and provide cite your thoughts.
Discuss the appropriate differential diagnoses for this patient.
Is the provider legally liable to explain to the patient the diagnostics that they are ordering? Why?
How many missed opportunities did Esteban have?
Should Esteban be sued? Why or why not?
Expectations
Initial Post:
Length: A minimum of 250 words, not including references
Citations: At least two high-level scholarly reference in 7th edition APA from within the last 5 years
