A 38-year-old male first presented to a multi-site primary care practice with a primary complaint of hemorrhoids. The physician diagnosed a bleeding hemorrhoid and gave the patient educational material to follow (blood pressure was 138/94). Seven months later, the patient was seen by the same physician, as well as a nurse practitioner, with a chief complaint of earwax (BP 110/90).
He was next seen in the practice two years later, by a different physician, for a persistent cough (BP 132/100). The diagnosis was bronchitis, hypertension, and smoking dependency. He received prescriptions for antibiotics and cough medicine. In addition, the physician recommended smoking cessation and asked the patient to return in one month for a blood pressure check. The patient did not return for the check up.
Seven months after that visit, the patient returned with right ankle pain (BP 144/98). He was seen by a third physician, who diagnosed a sprained ankle and prescribed Ibuprofen and an air cast. The patient returned for a one-month follow up with one of the earlier physicians, with continued ankle pain and swelling (BP 134/92). He received Indocine for his ankle pain, as well as recommendations that he follow a low salt diet, exercise regularly, and return in 3-6 months to have his blood pressure rechecked.
He returned in two months with continued foot and ankle complaints. He was seen by an NP, who referred the patient to Orthopedics (BP 130/88). When seen by Orthopedics a week later, his X-rays were negative for a fracture. He was placed in a walking cast, which was removed three weeks later.
Nine months later, the patient was treated for hemorrhoids (no BP noted). During a subsequent appointment soon after, the patient has earwax removed by an NP (BP 122/88).
The patient returned again six months after that, and was seen by a fourth physician. who diagnosed bronchitis (BP 144/88). In less than a month, he was seen for hemorrhoids (BP 165/105, upon repeat 130/90). The patient was asked to follow up with his PCP.
Two days later, the patient was seen by an NP for a routine health maintenance exam and blood pressure follow up. He was noted to have no family history of hypertension, but a positive history for diabetes. Blood work was obtained, and the patient was educated about life style changes and advised to return in three weeks for blood pressure follow up. The patient did not keep that appointment.
Two months later, the patient was seen by an NP to follow up on hypertension and laboratories. The NP’s impression was hypertension, hypothyroidism, and hypercholesterolemia. She prescribed medication for hypothyroidism and discussed smoking cessation. The patient was asked to return in 6-8 weeks.
Two months after that, at age 43, the patient was found dead by his wife, after having an acute myocardial infarction.