Ever made a wrong diagnosis???

zenman · May 16, 2007

I think about this also... another reason I'm thinking about just sticking with shamanic healing, lol:lol2:

core0 · May 16, 2007

okay, will not reveal too much info. suffice it to say that i made a differential diagnosis that involved either giving antibiotics or obtaining another test to r/o something more serious. i thought that i covered my bases by ordering antibiotics and then also ordering a diagnostic test. this test was scheduled for five days later. as it turns out, the pt developed problems over the weekend and ended up in the er, was diganosed with a potentially life-threatening problem and is in the hospital.

needless to say, i feel just awful. i did speak with the physician and he said that when i determined that the pt needed the test to r/o a more serious problem, i should have had it scheduled that same day or sent the pt to the er.

so....my question to you more experienced nps/apns, is how do you get over this feeling of making a mistake? then...how do i face this pt?

thanks for any input.

not an apn but definitely feel for you. as long as human beings are involved in medicine their will be mistakes made. you made a decision and it didn't work out. the important thing is that you learn from the mistake and don't repeat it. without knowing the details it is hard to tell if your doc is right. there are a few tests that i would run that i would do that day without sending the pt to the er.

you made the assessment and obviously at that time the patient didn't need to go to the er. it is hard to second guess that. at times you may be at the beginning of an episode instead of in the middle. the patient may decompensate wether you do anything or not.

the other part is that you may change the way you do testing. if i have someone that i am concerned about and i want a test right away then i walk them over to the scheduler and tell the scheduler face to face that i want the test today or tomorrow. if there is a problem with this they know to come get me. if i get flack from the insurance company (it will take a week to approve for example) then they go to the er and i make a note why. in this case i also document that i told the patient to go to the er if they get worse.

ultimately you will make more mistakes in your medical career. it is part of the job. the trick is to not make the same mistake twice and to err on the side of caution. this will probably change the way you do things in the short term. look at what you did. was there any reason to do things differently with the information you had at the time. if no then move on. if yes then learn and move on. it is ok to learn from this. don't let it consume you.

david carpenter, pa-c

Trauma Columnist · May 16, 2007

Zenman - thanks. Sometimes when the buck stops with you, it stomps on you - lol.

David - hindsight is always 20/20. Had I known what would happen, yes indeed, I would have been more agressive. Could I have foreseen this? Probably not. Its just the pits to realize that you are fallible

Thanks both of you - I did talk this over with another NP in the practice and she agrees that with the knowledge and available assessment info that I had, that she would have done the same thing.

So...I guess you do live and learn. I will never do this scenario the same way again.

Editorial Team / Admin · May 16, 2007

I know we talked via pm, traumaRUs, but just wanted to come here and say, get right back on that horse.

((((HUGS))))

Trauma Columnist · May 16, 2007

Siri - thanks much!

UM Review RN, ASN, RN · May 16, 2007

So sorry this happened, trauma, don't let it stop you. We can't predict everything and it's quite common for me to get patients who say, "I had an appointment today to check this out but I today I felt so badly, I had to come to the ER." Which I translate to mean that the doc recognized the problem and then the problem became severe after the patient was seen.

I'd have you for my NP any day. :icon_hug:

Trauma Columnist · May 17, 2007

Aw Angie - thanks so much! I really needed that!

Rhfish2 · May 17, 2007

I work in a cardiology practice. I work with 2 PA's and myself, the only NP, one of the PA's recently dx a chest pain as GERD and put the patient on a PPI. The patient returned 3 days later without relief. After a more thorough history I recommended a nuclear stress test the next day. The patient had severe coronary disease and was sent straight for a cath and subsequent CABG, NONE OF US are mind readers, we do our best. I always tell ptients if their symptoms worsen go to the ER (and place it in the note), this way you cover your butt. Good luck and don't be hard on yourself.