Commentary by David M. Lang, JD, PA-C, an experienced PA and a former medical malpractice defense attorney who practices law in Granite Bay, California. Cases reprinted with permission from MedicalAttached is articles. It deals with importance of doing an actual physical assessment of your patient. I'm often asked why we need to know all these skills when modern diagnostics are available. This article addresses that question. Review these articles and leave your comments.
5/13/2014www.clinicianreviews.com/index.php?id=31613&type=98&tx_ttnews[tt_news]=250897&cHash=da03e20e36 All for Want of a Rectal Exam David M. Lang, JD, PA-C 04/30/14 2014;24(5):17-18 Commentary by David M. Lang, JD, ? PA-C, an experienced PA and a former medical malpractice defense attorney who practices law in Granite Bay, California. Cases reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, XXXXXXXXXX. In January 2008, a man presented to the emergency department (ED) of a Florida hospital with complaints of headache and rectal pain. He was seen by Dr. C., who did not perform a rectal exam and discharged the patient with a diagnosis of acute headache. The following day, the man returned to the ED with right lower quadrant pain. He was evaluated by a PA, who noted painful urination and erythema in the groin. The PA diagnosed dysuria, tinea cruris, and “probable exposure to sexually transmitted disease.” Two days later, the patient went to the ED again, complaining of severe bilateral abdominal pain, rectal and head pain, and shortness of breath. Dr. N. evaluated him and ordered labwork, including a complete blood count and d-dimer qualitative study, and CT of the pelvis. These revealed an elevated white blood cell count and extensive soft tissue emphysema in the pelvis. The radiologist reported concern about a “perineal soft tissue infectious process” and noted that he and another radiologist had reviewed the findings with an ED physician. The following morning, Dr. O. assessed the patient and admitted him with a diagnosis of possible cellulitis. The patient was then transferred to another hospital. The plaintiff filed a lawsuit claiming that he actually had a necrotizing infection and that the delay in diagnosis resulted in the development of disseminated intravascular coagulation with thrombocytopenia. The plaintiff required numerous surgeries and wide local debridement of the tissue of his perineum,...
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