– THE DOUBLE BOUNCEBACK –
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…
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: