Ch. 4 – 36 y/o playwright who passed out

– THE DOUBLE BOUNCEBACK –

A 36 year old playwright who passed out

A 36 year old playwright who passed out

Otitis media. Constipation. Gastroenteritis. We may as well view these ‘wastebasket’ diagnoses as a red flag. How do you diagnose gastroenteritis or food poisoning without vomiting and diarrhea? Hard to explain… but it is also a bit unfair. We are looking at one patient we know had a bad outcome – this perspective is not present in the pulse of the ED, where the signal-to-noise ratio is quite a bit higher.

This case also brings to light how a suspicion of anxiety plays in to the evaluation and diagnosis. I have had patients conceal their diagnosis of panic, presumably to prevent me from making the same diagnosis (when they know they are now having an MI) and have had patients explain their symptoms as anxiety in order to get a quick refill of a Benzodiazepine. This is not easy work…

The story behind the story

Additional information about Jonathan’s story; Hospital statements of deficiency (obtained from the freedom of information act), an shortened autopsy report, the actual health commissioner report, and newspaper articles with indepth coverage of the events surrounding his death:

Hospital statement of deficiency FOIL

A – Autopsy – all edited

A – Health commissioner report

Newspaper articles about Jonathan

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One thought on “Ch. 4 – 36 y/o playwright who passed out

  1. Not only did the physician on the initial presentation neglect to acknowledge the nurses note which stated inspiratory chest pain, but he also mis-documented his own history. In the HPI it was noted this patient smoked marijuana but in the Past Social History, it said “negative, non-smoker.With incomplete, contradictory documentation who’s to say the physician failed to ask about cocaine abuse in this gentleman who possibly had an unfortunate hypertensive crisis that precipitated his Marfans-related aortic dissection or vasospasm MI? The physician who saw this patient on the bounceback is equally vague in his documentation when he noted him as “improved” on discharge. Is he improved from his initial presentation two days before? Obviously not because he’s having a 4 hour history of new symptoms and felt the need to go back to the emergency department. Or does he document that the patient has improved during the bounceback visit? It is hard to say because there was no follow-up progress note, repeat vitals, or disposition note on how the patient otherwise improved.

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