Monday, August 29, 2005
A roundabout diagnosis of C Difficile
It seems like it took a lot of work to come to a simple C Difficile diagnosis in a 15-year old girl: "She and her family are angry at doctors they allege did not think she was ill, removed her appendix because they wrongly believed she had appendicitis and accused her of being pregnant before finally making the right diagnosis . . .
. . . Doctors claimed she had either severe constipation, appendicitis, was pregnant - or, it is further alleged, was faking. Her appendix was removed at Pendlebury Children's Hospital in Manchester, but that was found not to be the problem . . .
. . . It was also feared she might have Crohn's Disease, a chronic inflammatory disease of the intestines. C difficile was eventually diagnosed after extensive tests."
It seems like it took a lot of work to come to a simple C Difficile diagnosis in a 15-year old girl: "She and her family are angry at doctors they allege did not think she was ill, removed her appendix because they wrongly believed she had appendicitis and accused her of being pregnant before finally making the right diagnosis . . .
. . . Doctors claimed she had either severe constipation, appendicitis, was pregnant - or, it is further alleged, was faking. Her appendix was removed at Pendlebury Children's Hospital in Manchester, but that was found not to be the problem . . .
. . . It was also feared she might have Crohn's Disease, a chronic inflammatory disease of the intestines. C difficile was eventually diagnosed after extensive tests."
Posted by Kevin |
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Comments:
Has anyone else noticed surgeons won't take obvious appendix cases directly to the OR anymore? This is an extremely dangerous case. The patient had an appendectomy and now is turning around and filing complaints that "appendix was normal" and was removed. This is a new income source for plaintiffs attorney's: Suing Surgeons for taking out a normal apppendix. It used to be acceptable to have a 10-20% normal appendix rate. With these new lawsuits a surgeon will never do an appendectomy without a CT scan, MRI etc. Many children are going to undergo unnecessary CT scans for defensive purposes. At least we won't get sued for all the cases of cancer that happen 20 years later.
# posted by 
: 11:33 PM
: 11:33 PM
I havne't seen this patients's records, but I doubt she was an obvious appendix case. For most equivocal cases in a female of reproductive age, an appendiceal CT or abdominal with contrast is almost always indicated.
Gasroenteritis and appendicitis ususally have key clues enabling a doc to tell them apart.
Since missed appendicitis ( not over-diagnosised appendicitis) is more likely to result in a malpractice or wrongful death lawsuit, docs should really brush up on the differential, esp. for female patients.
And there is no excuse, FWIW, for missing the infection here for so long.
Gasroenteritis and appendicitis ususally have key clues enabling a doc to tell them apart.
Since missed appendicitis ( not over-diagnosised appendicitis) is more likely to result in a malpractice or wrongful death lawsuit, docs should really brush up on the differential, esp. for female patients.
And there is no excuse, FWIW, for missing the infection here for so long.
# posted by : 9:59 AM
: 9:59 AM
I was not commenting on the differential diagnosis of abdominal pain in women. I was commenting on the new business of suing surgeons for taking out normal appendixes. I would be happy to CT every female of childbearing age who walks into my ED with abdominal pain. As far as i'm concerned they should order the CT scan from the waiting room. I just wouldn't want my 6 year old to have a CT scan if she didn't need one. Especially since multiple studies have shown 50% of hospitals don't dial down the radiation when they CT children. But for Malpractice purposes, Irradiate the living crap out of them.
# posted by : 11:53 AM
: 11:53 AM
"Has anyone else noticed surgeons won't take obvious appendix cases directly to the OR anymore?"
Yeah. The 10 minute evaluation for an 8 year old with abdominal pain to decide whether a surgical consultation is needed, or "come back in 12 hours for a recheck" has turned into 5 hour, 5 thousand dollar ordeal, with a double contrasted CT scan. This is one example how CJD and the medicolegal climate have made the system so much better
Yeah. The 10 minute evaluation for an 8 year old with abdominal pain to decide whether a surgical consultation is needed, or "come back in 12 hours for a recheck" has turned into 5 hour, 5 thousand dollar ordeal, with a double contrasted CT scan. This is one example how CJD and the medicolegal climate have made the system so much better
Your surgeons let you get away with just a double contrast CT? Where I work, I see teenage girls getting Ultrasound (first) then contrast CT (2nd) and then an MRI (3rd)when the first 2 are negative. I'm no longer a doctor; i'm a radiology travel agent.
# posted by : 8:49 PM
: 8:49 PM
In addition to the above tests did you also document "no history of ingrown toenail with antibiotics" to lawyer proof the chart by showing that you considered the diagnosis of c. difficile???
How about "patient denies giving herself a fecal enema with C-Dificile infected stool"? Would that cover your ass?
# posted by : 8:48 AM
: 8:48 AM
I came in with all the symtoms, stomach pains, vomitting, constipation to the ER. They did a cat scan and did not see anything wrong with the appendix. My white blood cells were 15.5. They sent me home to die and 2 days latter I had an emergency appedectomy surgery. My appendix had ruptured and peritinitis was every where. My surgeon didn't know if I was going to make it. I was in the hospital for 2 weeks. I was in a 5 star hosptial. How can something like happen with today's technology?
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# posted by : 11:51 AM
: 11:51 AM
