Missed diagnosis - just a vent

[Nascar nurse, ASN, RN]

Just trying to understand how this happens & thank God I knew enough to save myself.

Went to the ED over the weekend with complaints of horrible calf pain and swelling and a prior history of a DVT. ED was very crowded and staff very busy. Was put on a gurney in the hallway and told someone would be with me soon. Lab showed up and drew blood, transport person showed up and escorted me to ultrasound (which was done) and back to ED to wait for results. Sat in ED a total of 3 hours before a nurse or MD ever came to room to actually look at my leg. Nurse shows up and does brief assessment & admits "I think you got lost in the shuffle today". NP comes to room shortly after nurse leaves and tells me US shows no clot and I'm free to leave.

Next morning my calf is more swollen and way more painful! Call my primary MD and go in for visit. She tells me an US is rarely wrong & gives me a look like "Oh brother, another nurse with a self diagnosis". Long story short I insisted on a d dimer and she finally gives in. She calls me later in the day to congratulate me on a good call and informs me my d dimer is 3000. Was started on Lovenox and coumadin last night. Second US today confirms a clot from mid thigh to lower calf - 100% occlusion.

Now this didn't develop in just 2 days. I'm really gonna be angry when I get this hospital bill.

[himilayaneyes]

That is crap, but I'm very glad that you knew enough to figure this out yourself. As far as the hospital bill, call your insurance company and appeal it. Believe your insurance company doesn't want to pay for this. They'll be glad to get the call.

[Aymese]

As MDs have told me, an echo is only as good as the person performing the exam. Would it be possible that the ultrasound tech did a poor job in her exam?

I'm sorry that happened to you..pretty disconcerting that you were sent home. But glad you were insistant in getting the diagnostic tests that you needed!

[OttawaRPN]

Forget "physician, heal thyself." In reality, it's "nurse, heal thyself."

Great call on your part, you circumvented a potentially disastrous situation. Always trust your instincts.

I'd fight that hospital bill, though.

[diane227, LPN, RN]

One should never rely strictly on a test to make a diagnosis. Frankly, I would write a letter of complaint and let them know that you have no intention of paying the bill. Make sure you notify the physician group as well. They probably bill separately from the hospital.

[opensesame]

I had a serious surgical error occur when I was in the hospital after I had my last child during a tubal ligation. My physician took complete responsibility for it, and everybody makes mistakes, but you have to wonder why it has to be YOU.

My OB/GYN told me after that happens that the worst stuff always happens to people that have initials after their name (RN, MD, etc.) Indeed, I just had a valve replacement patient about a month ago that was a physician that had to be re-opped for a pericardial effusion. He told me during the course of the day that he had five surgical complications total. Gotta love it.

[Nascar nurse, ASN, RN]

That is crap, but I'm very glad that you knew enough to figure this out yourself. As far as the hospital bill, call your insurance company and appeal it. Believe your insurance company doesn't want to pay for this. They'll be glad to get the call.

I almost called insurance company today but worried that insurance company WILL refuse to pay and then hospital will hold me responsible for entire bill - and you know they will sue the heck of out of ya to get their money.

[Jolie, BSN]

One should never rely strictly on a test to make a diagnosis.

So true.

I had a tubal pregnancy that went mis-diagnosed for well over a week after symptoms began. 2 different doctors relied on high-tech testing and were wrongly reassured by false (misinterpreted) results. Meanwhile I had classic symptoms of an ectopic that neither one paid any attention to. Neither one bothered to do an old-fashioned pelvic exam, either.

Fortunately, I lived to tell the tale and had a Come to Jesus talk with them both. I don't think either one will make the same mistakes again.

[AnnieOaklyRN, BSN, RN, EMT-P]

D-Dimers can come up positive, even if you do not have a DVT! You could have a clot anywhere... the ultrasound would be more accurate to pic up a DVT!

[regularRN]

This is because modern MDs rely so much upon high tech tests etc. that they have lost all the diagnostic skills involved in a thorough physical assessment and clinical experience... this is where the RN has an edge. But I am - of course - sorry to hear of your plight.

[Nascar nurse, ASN, RN]

D-Dimers can come up positive, even if you do not have a DVT! You could have a clot anywhere... the ultrasound would be more accurate to pic up a DVT!

Trust me.. I'm very well aware of this. Did you read sequence of events in first post?

Did I mention that as of this point not a single health care provider has listened to my lungs. I find that odd too, although I am not having any outward signs of respiratory distress.

[AprilRNurse]

D-Dimers can come up positive, even if you do not have a DVT! You could have a clot anywhere... the ultrasound would be more accurate to pic up a DVT!

She did have an u/s to confirm...