Description
Discuss the appropriate differential diagnoses for this patient.
Calf swelling is a frequent presentation in family practice, often indicating either a manifestation of chronic underlying diseases or an acute problem with potential life-threatening consequences. It is imperative to discern between acute and chronic swelling to guide the assessment effectively. Deep vein thrombosis (DVT) emerges as a significant concern due to its association with morbidity and mortality. Virchow’s triad, encompassing venous stasis, initial damage, and hypercoagulability, underscores the thrombogenic factors contributing to DVT. Risk factors, including immobility, obesity, pregnancy, and trauma, heighten the suspicion of DVT. Clinical findings and history, though challenging, play a crucial role in diagnosis. The national Institute of Health and Care Excellence provides evidence-based recommendations, emphasizing the need for a systematic approach. The Two-Level DVT Wells Score, considering clinical features like recent surgery, immobilization, and localized tenderness, aids in estimating the clinical probability of DVT. Swift action, including a venous duplex ultrasound scan within four hours, is recommended for high-risk cases, supplemented by interim anticoagulation if necessary (Ray, 2021).
Pulmonary embolism (PE) is a consequential consideration, particularly in patients with respiratory symptoms. Risk factors such as immobilization, recent surgery, malignancy, and previous venous thromboembolic disease heighten suspicion. Female sex hormones, notably estrogen, contribute to hypercoagulability, increasing the thrombotic risk. PE diagnosis involves imaging modalities like a cat pulmonary angiogram or echocardiography, revealing pulmonary artery emboli and associated cardiac abnormalities. Prompt administration of anticoagulation is imperative upon confirming a PE diagnosis (Marshall & Fares, 2018).
Is the provider legally liable to explain to the patient the diagnostics that they are ordering? Why?
Tips to Avoid Litigation: to minimize the risk of litigation, healthcare providers must prioritize developing strong relationships with patients and their relatives. Respectful and honest communication, coupled with active listening, fosters trust. Remaining current with medical knowledge and acknowledging mistakes demonstrate professionalism. Thorough documentation, including date, time, and signatures for every chart entry, is essential. Obtaining informed consent for procedures involves discussing common risks, potential mortality, and alternative treatments. In the face of adverse events, prompt apologies, immediate corrective actions, and transparent communication are crucial. In the scenario described, an apology to the patient and spouse for the oversight followed by corrective measures, or directing the patient to the emergency department to get an ultrasound of the leg there, would have been imperative in mitigating potential legal consequences (Goroll & Mulley, 2020).
How many missed opportunities did Esteban have?
Esteban missed noticing the serious risk of DVT in this patient, which led to a late diagnosis and patient’s death. He also failed to explain the purpose of the lower extremity duplex, and the potential DVT complications. Esteban’s communication with this patient was not clear. This was a missed chance to involve the patient in decisions about his care. Esteban should have used the existing guidelines of care and not his personal opinion in diagnosing this patient. When the patient reported continuing swelling of the leg, Esteban should have sent him them straight to the emergency department. Instead of waiting for ultrasound results, causing a delay in treatment.
Should Esteban be sued? Why or why not?
The decision of whether Esteban should be sued involves a consideration of several factors. Esteban’s misdiagnosis, which contributed to the patient’s death, constitutes a significant breach of the standard of care. Failure to listen to the patient and lacking clear communication further adds to the complexity of the situation. Additionally, not adhering to existing guidelines of care raises concerns about Esteban’s adherence to established protocols.
References
Goroll, A. H., & Mulley, A. G. (2020). Primary Care Medicine Office Evaluation and management of the adult patient. Wolters Kluwer.
Marshall, P. S., & Fares, W. H. (2018). Pulmonary embolism. Elsevier.
Ray, M. D. (2021). Multidisciplinary approach to surgical oncology patients. Springer.
Peer Responses:
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Relate to another journal article.
