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Old 06-09-2012, 10:59 PM
 
491 posts, read 1,973,094 times
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Quote:
Originally Posted by stan4 View Post
While I don't agree with that doctor's assessment or statement about how young you were (that was just dumb), only one in every 100 patients who develops DVT dies due to pulmonary embolism.

So let's not get overdramatic, ok?
There are clots and there are clots - mine ran from ankle to groin and the specialist told me, in a nice bedside chat, that he had never seen someone alive with that extent of a clot. So don't tell me about drama.
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Old 06-10-2012, 05:05 AM
 
Location: Bella Vista, Ark
69,278 posts, read 79,469,982 times
Reputation: 38646
Quote:
Originally Posted by Chava61 View Post
I was wondering how often medical misdiagnosis occurs in the ER meaning the patient is sent home with a wrong diagnosis. Then the patient needs to return within 48 hours to the ER and more tests are done. Then a potentially life-threatening situation is found and the patient needs an emergency operation as soon as possible.

Any thoughts or comments on this?
Like anything else in life and in medicine, mistakes are made; sad but true. Our experience has been, if anything, the oppsoite, when there has been any doubt they have kept us, at least overnight. it probably happened more, years ago, when there wasn't as many tests and good diagnonses like we have today. Chava, I don't know where you live, but I am shocked you were not given anything to sign. Both here and in NM you sign a reslease, stating you choose not to stay. Everyone needs to remember, there are millions of people who go to the ER daily and we hear about the bad experiences, not all the good ones.

Nita
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Old 06-10-2012, 05:13 AM
 
30,325 posts, read 31,191,100 times
Reputation: 14005
Quote:
Originally Posted by stan4 View Post
Lol...9 times out of 10, people complaining of side pain DO NOT have appendicitis.
9 times out of 10 (actually, more like 99 times out of 100), people complaining of chest pain don't have a heart attack, either.

And guess what? I guess patients forget to read the book before they come to the ED with their complaints...because textbook presentations make up a very small percentage of appendicitis, heart attack, and other life-threatening things.

To answer the op, it's tough because people present their diseases differently, and remember, diseases evolve. You don't just BAM have the disease. It starts off with this...then you get a little of that...then the next day you have something over here...and then after enough days go by, it becomes obvious. But it's an evolution. That's why most ED discharge instructions have so many warnings. So you can watch for the evolution of your disease and come back if the next step happens.
By the time, I arrived at the ER the first time, I had extreme pain all over my stomach area (although it started in the lower right hand side). I couldn't walk and had to take an ambulance to the hospital (which actually walking distance from where I live). I was checked for heart issues and was giving a stomach sonogram as well as a chest x-ray. But when I described the symptoms over the phone to my regular doctor, he thought it could be appendicitis (which turns out to be correct) even though ER didn't diagnose it the first time I was there. So again I am left wondering why my regular doctor thought of appendicitis when the ER didn't find it the first time I was there and misdiagnosed me. Then less than 48 hours I was back again and it turned out to be appendicitis.
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Old 06-10-2012, 05:18 AM
 
30,325 posts, read 31,191,100 times
Reputation: 14005
Quote:
Originally Posted by nmnita View Post
Like anything else in life and in medicine, mistakes are made; sad but true. Our experience has been, if anything, the oppsoite, when there has been any doubt they have kept us, at least overnight. it probably happened more, years ago, when there wasn't as many tests and good diagnonses like we have today. Chava, I don't know where you live, but I am shocked you were not given anything to sign. Both here and in NM you sign a reslease, stating you choose not to stay. Everyone needs to remember, there are millions of people who go to the ER daily and we hear about the bad experiences, not all the good ones.

Nita
I only signed something when I was released after being hospitalized for a few days and then I was not given a choice to stay on at the hospital (which I would't have wanted to at that point).
The first time I was in the ER, I was not even released by an ER doctor. The ER doctor that saw me when I came into the ER, came to tell me that he was finishing his shift and couldn't wait for the results of my stomach sonogram and therefore another doctor would release me. Well the other doctor never spoke to me or saw me and after waiting another hour a nurse came and gave me some documents to give my regular doctor with my diagnosis and what I should do after came home. The nurse told me what I had but didn't go over the written instructions (which I read after I got home).
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Old 06-10-2012, 04:25 PM
 
Location: Bella Vista, Ark
69,278 posts, read 79,469,982 times
Reputation: 38646
Quote:
Originally Posted by Chava61 View Post
I only signed something when I was released after being hospitalized for a few days and then I was not given a choice to stay on at the hospital (which I would't have wanted to at that point).
The first time I was in the ER, I was not even released by an ER doctor. The ER doctor that saw me when I came into the ER, came to tell me that he was finishing his shift and couldn't wait for the results of my stomach sonogram and therefore another doctor would release me. Well the other doctor never spoke to me or saw me and after waiting another hour a nurse came and gave me some documents to give my regular doctor with my diagnosis and what I should do after came home. The nurse told me what I had but didn't go over the written instructions (which I read after I got home).
wow, we have had experiences with emergancy rooms is the DC area, Dallas area, Abq and here in NW Ar, I can say, we couldn't have gotten better care anywhere. The last time I was in the ER which was what my doctor though might be Pnuemonia, the instructions were not quite as clear as they could have been, but I certainly was given enough information to know what to expect. I am sorry you have had a bad experience.
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Old 06-12-2012, 09:02 PM
 
774 posts, read 1,340,701 times
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The issue of evolving symptoms is totally spot on. Sometimes people present early in an illness where their symptoms really do not point to anything specific or dangerous. Leg pain is not going to be diagnosed as a blood clot unless there is significant swelling. Especially in someone without risk factors (recent surgery, etc). Side pain isn't going to be diagnosed as shingles before the rash starts. Appendicitis may not be diagnosed early as it also evolves--for example "classically" it starts as pain at the belly button, then moves to the side. So if you come with pain at your belly button, you're not vomiting, you don't have fever, it will be easy to miss.

Another thing to keep in mind is cost to the patient (money and risk). A young guy who has chest tenderness and chest pain may be sent home from the ER in a lot of cases with "musculoskeletal pain". However, I saw this guy with these symptoms end up with a much needed stent because someone decided to do a stress test on him (which for a majority of young people with his symptoms would be a huge waste of the patient's money and time). Medicine is ALL about odds. The odds of a person who presents with symptoms like this are very low for having such and such problem--thus we will not order xyz expensive test. Seriously,you would be upset if you got a blood count, a throat culture and a mono antibody test every time you went in to the dr with a sore throat. It's a balance. Sometimes it doesn't work in favor of making the diagnosis early.
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Old 06-13-2012, 10:35 AM
 
Location: In a house
13,258 posts, read 34,613,675 times
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This "misdiagnosis problem" is pretty understandable. It's also a very old problem, for which there is no practical remedy. An old medical aphorism:

"When you hear hoofbeats behind you, you don't expect to see a zebra."

This means, you're looking to rule out the most obvious problem first, before you bother testing for the more obscure and uncommon.

It's also the premise of Occam's Razor: plurality is not to be posited without necessity.

Translation to modern language: try the more complex answer only after you've ruled out the simplest.

Another aphorism, which is specific to medicine, is Sutton's Law: perform first the diagnostic test expected to be most useful.

Translation into non-medical useage: It was a misphrase attributed to a guy named Sutton who robbed banks. He was asked why he robbed banks, and he supposedly said "because that's where the money is." He claims he never said that, but the story is where Sutton's Law came from.

When presented with a puzzle, the most efficient method of solving it, is to rule out the obvious first. Medical diagnoses is not immune to the pragmatic application of this theory.
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Old 06-13-2012, 11:14 AM
 
Location: Southern California
3,115 posts, read 6,990,476 times
Reputation: 3657
I think some of you have unrealistic expectations as far as what doctors and hospitals can do. They are not gods or magicians - and they have to follow established procedures to rule out the more logical causes first.

Just because it may take a doctor more than one visit to diagnose the true problem, does not necessarily mean he or she made mistakes the first few visits - it just means it took a while to rule out the more obvious explanations. If you have a problem and one visit does not solve it, then go back. And go back again and again, if necessary.

Expecting to get a solution with just one visit, while nice when it happens, is not realistic in all cases.
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Old 06-14-2012, 06:54 PM
 
Location: North Carolina
102 posts, read 271,558 times
Reputation: 221
Quote:
Originally Posted by Annie53 View Post
A friend of mine kept getting chest pains.

He went to a local hospital..... they told him to make an appointment with a gastroenterologist and sent him home.....he made an appointment the next day.

The next time he had the pain he went to our other local hospital.....he was told the same thing. {while waiting for his gastro appointment}

The third time he was visiting a friend in the hospital in a nearby city when he had the same chest pains. {still waiting for his appointment date}

A nurse there told him to go to their emergency department immediately.

This time they diagnosed a heart attack. The very next day he had a stent put in at that hospital.

His ex mother-in-law saved his life.....that is who he was visiting at the third hospital. LOL
I don't know where this was at, but it was very poor care. I currently work in medical/surgical oncology, but I used to work in the ER. We have a protocol called STEMI (ST- segment myocardial infarction) that we use for all patients presenting with chest pain. This means that we treat all chest pain patients as if they are having a heart attack. As soon as they arrive, we perform an EKG, put them on the monitor, draw blood, start two IVs, and administer some medications. We then do a chest x-ray and other diagnostic tests as needed. Most of this happens within 30 minutes of arrival.
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Old 06-14-2012, 07:20 PM
 
Location: Cartersville, GA
1,253 posts, read 2,857,902 times
Reputation: 1080
Quote:
Originally Posted by NCRNStudent View Post
I don't know where this was at, but it was very poor care. I currently work in medical/surgical oncology, but I used to work in the ER. We have a protocol called STEMI (ST- segment myocardial infarction) that we use for all patients presenting with chest pain. This means that we treat all chest pain patients as if they are having a heart attack. As soon as they arrive, we perform an EKG, put them on the monitor, draw blood, start two IVs, and administer some medications. We then do a chest x-ray and other diagnostic tests as needed. Most of this happens within 30 minutes of arrival.
This is indeed the standard of care for chest pain. Based on earlier posts, I am not sure whether or not these tests were performed during the first few visits the the emergency rooms. He simply said he was presented to the ER, and told to see a GI specialist. I am guessing that the MD did some tests before making this referral. It's certainly plausible that they were indeed performed, and that they were all negative for an acute MI.
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