Description
Discuss the appropriate differential diagnoses for this patient.
The presenting signs and symptoms that Mr. Shien presents with to the office are swelling in his calf, difficulty walking, and pain behind the knee. The differential diagnoses that I would consider for this patient would be #1 deep vein thrombosis (DVT), #2 cellulitis, and #3 lymphedema. The rationale for DVT being one of the differential diagnoses is because when present, a DVT in the lower extremities will cause calf pain, swelling, redness, pain to the superficial veins, and pain when walking (Waheed et al., 2023). Cellulitis is a possible diagnosis because it is a common skin infection which can cause erythema, pain, and inflammation to the affected area (Brown & Watson, 2023). Lymphedema is the third differential diagnosis because when there is an imbalance in the drainage of the lymphatic fluid in the body, it can lead to progressive accumulation of fluid in different areas of the body primarily the arms and legs, which in combination with swelling can also cause skin changes, pain, and secondary infections (Brix et al., 2021).
Is the provider legally liable to explain to the patient the diagnostics that they are ordering? Why?
The provider has the ethical and legal responsibility to provide an informed consent to Mr. Shien about the diagnostic test that he ordered. This is the process where to provider explains and educates the benefits, risks, or any alternative procedures to the patient, so they can be fully informed and decide if they wish to undergo the procedure or intervention suggested by the provider (Shah et al., 2023). In this case, Esteban failed to explain that the reason for the ultrasound was to rule out DVT, which could be a potentially urgent matter. During his last visit to the office, Esteban also failed to educate Mr. Shien on what a DVT was with the intention to prevent the patient from becoming anxious about the possible diagnosis, which is ethically wrong because there should be as much transparency as possible between the provider and the patient.
How many missed opportunities did Esteban have?
One missed opportunity was when Mr. Shien returned to the office 3 weeks after his initial visit and was describing newly emerging signs and symptoms, which were calf swelling, pain behind the knee, and difficulty walking. At this point, Esteban should have ordered the ultrasound when he noticed the circumference discrepancy between the lower extremities and from what the case study mentions, Esteban knew that a DVT was a possibility. Another missed opportunity was that the ultrasound was ordered as routine for the next day after the patient called the office for increased swelling and pain. Esteban should have instructed the patient to go to the ER at that time or call 911 if he was having any shortness of breath, chest pain, or palpitations. Esteban also failed to consult with his supervising physician, Dr. Stew, which could have had a different plan in mind for Mr. Shien.
Should Esteban be sued? Why or why not?
There were several missed opportunities for Esteban to change his plan of care and he did not, I believe it is reasonable for him to get sued. According to Bono et al., in the United States, patients may file a medical malpractice claim against a health care provider, which is usually described as the providers failure to give the level of care that a different provider with the same education, qualifications, and position would have provided to the patient in order to prevent the patient’s injury or death, like in the case of Mr. Shien (2022). I believe that Esteban had no bad intentions, but he did not take Mr. Shien’s concerns seriously and did not follow clinical guidelines which he should have followed based off of Mr. Shien’s presenting signs and symptoms.
References
Bono, M.J., Wermuth, H.R., Hipskind, J.E. Medical Malpractice. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470573/
Brix, B., Sery, O., Onorato A, Ure, C., Roessler, A., Goswami, N. Biology of Lymphedema. Biology (Basel). 2021 Mar 25;10(4):261. doi: 10.3390/biology10040261. PMID: 33806183; PMCID: PMC8065876.
Brown, B.D., Hood Watson, K.L. Cellulitis. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549770/
Shah, P., Thornton, I., Turrin, D., Hipskind, J.E. Informed Consent. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430827/
Waheed, S.M., Kudaravalli, P., Hotwagner, D.T. Deep Vein Thrombosis. [Updated 2023 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK50770
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