Case Archive
Internal Medicine
Ref. # 807301

A 30-year-old man went to his internist with complaints of tremors, shaking of the right hand, and enlarged breasts. He was referred to a general surgeon, who diagnosed gynecomastia and informed the patient it would resolve over time. The symptoms continued and were noted by the internist during two more exams during the next month. Six months later the man saw the internist because, in addition to the tremors and breast enlargement, he had developed an accelerated and irregular heart beat, anxiety, intolerance to heat, and weight loss. The internist ordered a thyroid test. Three days later the test was positive for hyperthyroidism. The internist telephoned the patient and prescribed Tapazol and Inderal, which the patient began taking. Three days later the man's wife found him unconscious on the floor. The EMT's attempts to revive him were unsuccessful. An autopsy found thyroid goiter, splenomegaly, hemorrhagic gastritis, and a prominent thymus. Cause of death was listed as focal myocarditis with necrosis with a contributing factor of thyroiditis and chronic hepatitis. A medQuest internist reported the defendant internist negligently failed during three successive visits to perform a thyroid or cardiac exam or obtain blood work with reference to the complaint of tremor. When hyperthyroidism was finally diagnosed, the internist failed to obtain an EKG or refer the patient to an endocrinologist. The lengthy delay in diagnosis contributed to the patient's death.

Internal Medicine
Ref. # 38418

A 67 year old Pennsylvania man was seen by his internist for chronic fatigue. A PSA was reported as 6.6 (0-4.0 is normal). On a rectal exam, the prostate was normal. One and a half years later the patient was seen by the internist for pre-op evaluation for hemorrhoid surgery. A 1 cm. node in the left anterior cervical area was found. The surgery was performed as scheduled. Eight months later the internist ordered a PSA test, which was reported as 25. A biopsy of the node showed prostate carcinoma. The patient underwent surgery for removal of the node. A medQuest internist opined that, upon noting the abnormal PSA level of 6.6, the treating internist negligently failed to order further testing, such as urological evaluation with sonography and biopsy. Additionally, there was negligent failure to refer the patient for a biopsy upon discovery of the node.

Internal Medicine
Ref. # 28048

A New Hampshire woman with a history of emphysema presented to the ER with chest and back pain and coughing. No X-rays were obtained and the patient was discharged. Eight days later she visited a primary medical doctor, complaining of continued pain. A chest X-ray showed large fluid collection and tracheal displacement. Three days later the patient was admitted to the hospital, where she died the following day. A medQuest internist reported the cause of death was septic process of the lung, heart and mediastinum, and perforated duodenal ulcer. The attending internist negligently failed to recognize the severity of the patient's condition and immediately refer her to the appropriate specialist.

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