Four months after giving birth, a 28-year-old patient presented at her physician’s office with complaints of epigastric, upper abdominal, and lower chest pain. She was seen by one of her physician’s associates, who confirmed epigastric tenderness and diagnosed gastroesophageal reflux disease, or GERD. The patient openly disagreed, saying it did not “feel like heartburn.”
Nonetheless, the physician prescribed ranitidine to reduce acid production. He also told the patient to make a follow-up appointment within four weeks if the pain did not subside, and that further diagnostic testing would be considered at that point.
The patient continued to experience pain, but did not make a second appointment. Two months later, when she brought her infant in for his six month visit, she sought out her primary care physician—even though she did not have an appointment. She conveyed what his colleague had diagnosed two months earlier and what medication she had been prescribed. The patient also informed him that the pain had not decreased. Her PCP wrote a prescription for another medication. He did not order any diagnostic testing.
Three months after that—five months after her initial complaints of discomfort— the patient returned to her primary care physician complaining of severe vomiting, diarrhea, reduced urination, and upper abdominal pain so severe that it made her cry, over the previous 24 hours. He found epigastric tenderness and administered a “GI cocktail” of Xylocaine, a local anesthetic, and Maalox. He performed no laboratory tests or radiological studies. The patient was discharged to home.
Later that day, the patient became so ill that she presented at a local emergency department where she was diagnosed with acute pancreatitis. She was found to have acute renal failure/anuria and irreversible kidney damage. After several months of dialysis treatments, the patient underwent a renal transplant that later failed. She is currently on dialysis.