A Summary of What Comes Back to Bite You...

http://archinte.jamanetwork.com/article.aspx?articleid=1656540

Above is a decent article on the most common reasons people end up in the ER, after he/she has seen their primary within the last 2 weeks. In other words, what were the most common "missed diagnoses."
One fault I found with the article, was that especially in the VA population, I imagine if a primary care provider saw a patient, was deemed to have a URI, and then ended up in the ER 14 days later with pneumonia, how do we not know that the pneumonia developed over the 14day interim period? Furthermore, with chest x-ray being a late indicator and often lagging clinical findings, would an x-ray 2 weeks earlier have changed anything? Regardless, the article serves good fodder for the lawyers against you in a deposition, so it is worth reading. A few pearls:
1. The #1 missed diagnosis was pneumonia.
2. The second most missed diagnosis was decompensated CHF.
3. Note that despite what the policy makers want you to do, nearly 79% of the "misses" involved issues in the "physician-patient encounter", and within this realm the largest area for mix ups (57%) was not ordering enough diagnostic tests. (Shhh....I know that is non trendy to say nowadays.) In other words, the creatinine, urinalysis, or x-ray was not performed and the patient was sent out.
4 Don't forget acute renal failure on the list. This is a major issues in the elderly, multimorbidity patient, where it is hard to "piece things together....and by the way their creatinine is 5."
5. I will use this article as a reminder...use caution with the bouncebacks.