Can people in the Medical profession answer only please?

Question

Are there National Guidelines that Medical Professionals are supposed to follow? An example is, a person goes to the Doctor with a strong Cough, Tightness in the Chest, and Shortness of Breath. During the Doctors exam the Doctor says he hears a rattle in the Chest which indicates fluid build-up. But he does not order Chest X-rays. Are there any guidelines that say Chest X-rays should have been taken? and before you tell me to get another opinion. it's too late. the patient passed away 2 days later of congestive Heart Failure?

The Doctor diagnosed him with Bronchitis.

Answer 1

There are no specific guidelines that any physician or medical provider is required to follow. Imagine the complexity of decision making in with all of the variations of various clinical presentations and medical histories. Depending on the setting, it is highly dependent on how a practioner might approach a presentation.

In the ER I refer to it as "bottom-up" medicine. You assume the worst possible case, ruling things out as you go. You may or may not actually fully treat the presentation, but you have ruled out that the person is in mortal peril. In Family Practice however you often go with the MOST LIKELY case, expecting that if symptoms get worse the patient will return or go to the ER.

We all want affordable healthcare. We ask our medical professionals to see 40-50 patients a day. We do not want unneccessary tests. Well all of that comes to a crashing halt the moment something goes wrong. Regardless of the work load, I do not know of a caring medical professional that would omit an important part of the diagnostic process because he/she was too busy, knowing that it might jeopardize his/her patient. Doctors cam make honest errors too.

I am not endorsing necessarily what the practioner did or did not do, but I know there are plenty of cases of bronchitis that I have diagnosed without getting a chest xray. The example you provide does not exclude the idea that the patient had BOTH bronchitis and CHF. I can imagine several circumstances where patients can exhibit flash pulmonary edema and decompensate substantially in a few hours time - let alone two days.

If this is someone you know or a family member, I am sorry for your loss. It is natural to look for someone to blame when things go badly. Unfortunately sometimes things look much more obvious in retrospect. If you feel like this practioner is really uncaring or is unconcerned or frankly is incompetent, then it would be wise to find another provider. If you think he/she is a good provider that made a mistake, I probably would stick with them.

Good luck.

Answer 2

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Answer 3

No there are not. It is left up to the physcian to determine what tests would be appropriate for the patient based on the history obtained through questions, previous medical history, and the symptoms presented by the pt. @ that particular visit. Just by the information you have given should give alarm to any physcian. The tightness in the chest and the shortness of breath asociated with rales for any one over the age of 45yrs should have @ a minimum earned them not only a CXR but also an EKG. Unfortuntely this was not done and it cost someone their life. People are very poor historians especially when it come to explaining to medical personal their medical Hx. (history). You don't mention if the person was on medications for heart problems. CHF doesn't happen over night. There is an underlying problem with the heart whether it was from previous MI's (heart attacks) or an enlarged heart, but something was causing the blood not to be circulated efficiently. There are usually more signs and symptoms related to CHF. They now actually have a blood test that can be done to determine CHF/ Heart failure called BNP ( Brain Natriuretic Peptide) You can find out more about this hormone @ www.webmd.com. There are so many other varibles that need to be considered in this particular situation that aren't mentioned in the brief question you asked, My advice ( and I realize it's to late for this situtation) is when ever you have some doubts about any medical decision being made about a loved one go to the ER. Hospitals have regulatory guidelines and strict policies that have to be followed. Most ER physicians and Hospital's are worried about being sued for malpractice and will have a tendency to err on the side of caution by ordering multiple tests so that they come up with a diagnosis that they feel is the correct one and then will act accordingly. As far as I'm concerned with the little bit you explain this MD was negligent and I would no longer be associated with him as a caretaker of my family or friends. I would tell everbody I knew what had happened and hopefully you will prevent someone else from suffering the same concequences. I'm so sorry for your loss.

Answer 4

The results of a chest x-ray would probably have only told the doctor what he already knew...that there was fluid build-up. Why expose the patient to unnecessary radiation exposure and expense for information that may not have been of any diagnostic value? I am assuming that the patient was put on diuretics and maybe antibiotics. A chest x-ray may not have altered the initial treatment plan.
The outcome is unfortunate, and sad, but may not have been entirely neglectful.

Answer 5

The doctor miss diagnosed the patient and didn’t follow proper protocol. As a doctor one should never minimize your diagnoses. In school we learn that you should always look at all the possibilities and make sure that you can rule out the more life threatening causes of the patient’s problem before you disregard them. Sadly this is a common occurrence as many doctors jump to conclusions and do not fully diagnose their patients. Here is a site that you can read more about the amount of medical errors per year.
http://www.mercola.com/2003/nov/26/death_by_medicine.htm

Answer 6

There are some specific guidelines which a medical answering service has to follow to give the answer the of any question, these guidelines are here read it carefully:-
Provide a facility to all those you call and provide the service in all 24/7 in a month.
They have provide the service for any question to answer any call.
Provide a well managed staff and service to any medical call.
Talk nicely to the patients or customer who call and make them feel comfortable while giving any information regarding medical care.

Answer 7

His diagnosis was fairly accurate but surely he/she treated the patient with medication.

Did this person have another illness such as COPD? Did this patient have cancer? Was this an elderly person? Many times this happens to older people. I am not trying to defend anyone, but other factors must be considered in answering this question.
Was this diagnosed by an ER doctor?
Was this diagnosed by his regular doctor?
The patient could have developed CHF in a matter of one day.

I am sorry if this was a relative of yours. For better answers, you can contact the American Medical Association for guidelines. If you are related, you can ask for the patient's medical records. If not, then suggest this to the surviving members of the family. They are entitled to the medical records if the patient was in the hospital at any time or in the doctor's office at any time.
If you have someone in your family with medical knowledge, who can understand the terminology used in the records, share it with them.

The guidelines or Hippocratic Oath state in the text "Do no harm."

You would also have to know what the secondary diagnoses were.

Hope I am helping you a little. People in the medical profession are not allowed to give yes or no answers or really even to diagnose and treat on a web site.

This is an interesting question and it sounds as if you are needing information because you are wanting to file a lawsuit, studying law, or medical student yourself.

Answer 8

most hospitals use clinical pathways which are guidlines set with what to do if a person presents with such and such symptoms..it amazes me that if someone came in with those symptoms you described was not given a chest x-ray...even if the patient was seen at a doctors office as opposed to a hospital er a chest x-ray should have been ordered...chf is a treatable condition

Answer 9

Yeah, that would be nice but they never will. These people lie and misdiagnose all the frigging time and get away with it. Two classes of people should have their legs shackled and dumped into the Mariannas Trench: Lawyers and those who practice modern medicine. The world would be a much better place!

Answer 10

It is totally up to the Dr. He probley should of got an x ray , some dr.'s go by clinical signs rather then waiting for tests. Which in this case turned out wrong. Pneumonia is heard through a 'crackle' in the lungs the dr. must have heard this and used antibiotics to treat pneumonia, which did nothing for CHF.