Scenario 3 PE in Clinic-Physician
1 month ago: Ms. Patty is a 37 yo woman with a PMHx of DVT associated with a broken leg in her 20’s who presents to your clinic as a new patient for contraceptive management. She has a new boyfriend and 2 children and does not want to get pregnant again. She says she was on the pill years ago and is interested in OCP’s given she concurrently has acne which the pill really helped with in the past. She is not up-to-date on her pap smear and last had a PCP over 5 years ago. The only other medical care she has received was treatment for chlamydia at planned parenthood about 2 years ago. She says she wants STD testing as well given her new relationship. You are booked for the afternoon but feel the pressure to do a pap/STD testing for this patient while you have her in clinic. You ask your MA to set up a pap/pelvic exam tray and get the exam done now. As an afterthought you write a quick prescription for her OCP at the end of clinic.
Today: The patient re-presented yesterday to clinic with tachycardia, tachypnea, and RLE erythema and swelling and you admitted her to the hospital. You are reviewing her chart today just make sure there wasn’t anything missed. You notice from her inpatient record she has been diagnosed with a PE. As you read your note from last month you do double take of her summary line. It says “remote PMHx of DVT” and your heart drops. You realize that you should not have prescribed an OCP given her history of DVT. In your rush to meet her and do the pap last visit you had not processed this critical piece of information. You decide to walk across to the hospital and see the patient in her room to do an error disclosure.
Situation: You are in the patient’s room in the hospital. Discus with the her the diagnosis of PE and the error you committed. Use the disclosure framework.
How to Disclose:
Inform the patient an adverse event occurred.
Describe what happened.
Stick to the facts, do not speculate
Use easy to understand language
Review implications for the patient.
Now
Future
Apologize and acknowledge responsibility.
Update on planned actions.
Plan to close the loop.