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Legal Lessons: Hip pain with 7 Bounceback Visits

Mike Weinstock, MD and Matthew DeLaney, MD
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No me gusta!

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There are no clinical findings which definitively diagnose or ‘rule out’ a DVT. When this diagnosis is suspected, a doppler study should be done. If missed, a pulmonary embolism may occur.

 

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John B., MD -

Dear Matt and Mike:
I am not convinced the diagnosis was DVT. Was there leg swelling, redness, anything to suggest DVT? Are we to believe that crutches were needed for leg pain from DVT with no physical findings? Was there tenderness anywhere? Somewhere in the back of my mind I recall that multiple PEs are not an uncommon terminal event when the cause of death is not primarily from DVT.
Unconvinced in Pacific Palisades,
John Bibb, MD FACEP

Mike W., MD -

Hi John and thx for your thoughts. A little more to the story is that there were 2 autopsys and the first showed athersclerotic dz and the second was a private autopsy which showed multiple PEs. Unfotunately we had a detailed summary of the case but not the actual autopsy report, so it is difficult to say for sure as our report did not detail the extremity autopsy findings. John, you may be right and this certainly was an issue at trial as the defense argued there were not findings of DVT at presentation. That is why the teaching points/discussion points are interesting in this case: importance of follow up, importance of the patient understanding rremaining diagnostic uncertainty, thx for your comments!!!
M

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Hippo Urgent Care RAP July 2020 Written Summary 823 KB - PDF

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