Family NP Case Study
Many people in the United States and other parts of the world seek professional healthcare services throughout their lifetime. According to Heller (2017), an average of four visits to physicians per person were recorded in 2015. With these visits, the patients expected high-quality of care that promotes health and recovery from illnesses to achieve a better quality of life. Unfortunately, a significant portion of healthcare encounters is associated with negligence and malpractice that cause poor health outcomes, including morbidities and mortalities. For example, medical malpractice is the third leading cause of all American deaths since it is responsible for more than 80,000 to 160,000 annual demises (Elkamel & Curry, 2016). Primarily, medical malpractice comprises medication, surgical, anesthesia, and, most importantly, diagnosis errors; besides, negligence ensues when healthcare professionals fail to discharge their duties correctly, hence leading to harm or injury. In the case of the 31-year-old male patient who died from cancer of the colon, malpractice, and negligence were widespread due to the failure of the nurse practitioner and physician to uphold the standards of practice; thus, these professionals and their institutions should face legal charges to compensate for damages to the patient.
Defendants and Areas of Negligence
In healthcare, those who break the law should be judged for their behaviors based on their code of ethics and standards of practice. Usually, the litigation system aims at compensating the plaintiffs due to malpractice and negligence committed by defendants, hence discouraging future law-breaking behaviors and exacting corrective justice (Kass & Rose, 2016). In this case, the male patient experienced professional negligence and malpractice due to the failure of the nurse practitioner and primary care physician to provide quality as well as safety services after making a proper diagnosis or referral to the most suitable consultant before the situation could worsen. As a result, the definitive diagnosis was realized in the advanced stages of the disease. In addition to causing immense suffering to the patient, these two health professionals indirectly contributed to the loss of life.
Failure to Provide Appropriate Care
Fundamentally, many areas of negligence can be singled out in the case study. First, apart from the inability to eat, the patient reported complaints of burning and cramping abdominal pains during the initial visit. However, there is no evidence of any other examination or investigation this nurse performed or ordered, which amounts to negligence despite the subjective information acquired from the patient’s case. Even after setting up a complete physician exam, nothing was done until November during the second visit. Usually, missing to offer the necessary care is a form of negligence (Pozgar, 2016). It is during this visit that a history of chewing tobacco, colon cancer in the family, massive coffee intake, as well as increased abdominal pain and loose stools. Primarily, the nurse failed to acquire this data during the first visit through a complete history taking and physical examination.
Failure to Refer and Attend to the Patient
The most critical area of negligence for the nurse practitioner is failing to refer the patient even after not making a definitive diagnosis of the actual problem; something that prolonged the patient’s suffering with inappropriate treatment. According to Pozgar (2016), failing to refer a patient to the relevant specialist for further examination, review, or therapy amounts to negligence. To make it worse, it is evident that the nurse practitioner did not order any diagnostic tests, perform a rectal exam, or refer the patient to the appropriate specialist. Although it was right to order an upper gastrointestinal series with contrast to rule out an ulcer or gastritis, much could have been done to establish the appropriate diagnosis. Later, the negative results of ruling out the two potential diagnoses were forwarded to the primary care physician. The fact that the medical practitioner did not attend to the patient or review a chart is an act of negligence (Kass & Rose, 2016). In this way, both the nurse practitioner and physician failed to discharge their primary care duties to save the life of this person.
When a healthcare professional fails to discharge duties and responsibilities as per the established standards of practice, malpractice and negligence are the primary outcomes. Usually, a health professional has an obligation before a patient, failure to which results in breaching the standard of care (Raveesh, Nayak, & Kumbar, 2016). In this case, the physician did not even attend to the patient despite the referral. For negligence to be confirmed, the plaintiff should be able to demonstrate that the negligent actions of the care provider were responsible for the injuries or suffering that could have been avoided if the appropriate intervention could have been executed (Kass & Rose, 2016). Possibly, a failure of the medical practitioner to examine or review the patient resulted in the subsequent denial to make the correct diagnosis; as a result, continued suffering and progression of the disease were not halted. Further, negligence can occur in the form of failing to make an appropriate follow-up with a patient or improperly administering the medications (Raveesh et al., 2016; Kass & Rose, 2016). Already, there was no follow-up for this patient on the side of the physician. For the nurse practitioner, the prescribed medication was not appropriate for the disease since it was aimed at treating gastritis, which had been ruled out by gastrointestinal investigations.
Misdiagnosing the Patient
The level of negligence varies depending on the entire context that comprises the involved individual, time, place, and the level of complications. Kim (2017) defines malpractice as a medical error of negligence that includes misdiagnosis of illnesses by health professionals and inadequate treatment among others. In the case study, the person was being treated for gastritis, something that the nurse practitioner deliberately knew that it was not the definitive diagnosis after the negative gastrointestinal investigations. Despite the fact that almost 50% of all patients with complaints of abdominal pain fail to receive an accurate diagnosis, the nurse practitioner is not justified to stop evaluating alternative causes of gastrointestinal symptoms (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The nurse persisted with the diagnosis of gastritis despite the complaints of persisting and worsening in the presence of the treatment interventions.
Differential Diagnoses and Reflection on the Case
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Based on the complaints and the history of the patient in the case study, many differential diagnoses can be made. Since most of the gastrointestinal symptoms are non-specific, the differential diagnoses comprise peptic ulcer disease, cancer of the colon, gastritis, gastroduodenal ulcers, and gastroesophageal reflux disease. After identifying these potential gastrointestinal illnesses, it could have been critical to rule out some of them by ordering laboratory and radiological investigations among other diagnostic tests before reaching a definitive diagnosis to formulate and implement a plan of care. Keller et al. (2018) report that in the presence of abdominal pains, loose stools, inability to eat, and altered gastric emptying, it is critical to investigate and rule out the presence of gastrointestinal inflammation or malignancy. By examining stool samples, it could have been possible to rule out gastritis due to the lack of gastrointestinal inflammation as well as the subsequent absence of fevers.
Already, the patient had a history of colon cancer in the family, which could have been a primary issue to determine that the symptoms are suggestive of this neoplasm. In this case, the advanced practice registered nurse seems to have had the independence to make decisions by examining the person at all levels instead of delaying to derail the treatment and recovery efforts. With this practice autonomy, it could have been prudent to order for colonoscopy and abdominal CT scan to find out the presence of gastrointestinal masses or abnormalities. Patients with gastrointestinal symptoms require a colonoscopy exam, especially when having a family history of colorectal cancer and symptoms that suggest the presence of the disease as a first-line investigation (Than, Witherspoon, Shami, Patil, & Saklani, 2015). Apart from that, people with these symptoms should be examined for colorectal bleeding, signs and symptoms of anemia, changes in bowel habits, abdominal pains, and weight loss (Than et al., 2015). From the case, the person had already presented with changes in bowel habits and abdominal pains; therefore, examining for the remaining features could have been an appropriate move for the nurse practitioner. In the case of violating the legal scope of practice for the nurse practitioner, it is critical to seek and receive physician authority to perform some of these roles. Besides, the nurse could have acted as a patient’s advocate to achieve quality care by actively collaborating with relevant professionals to make the necessary assessments for early diagnosis and prompt treatment of colon cancer.
Conclusion and Verdict
From the mistakes, both the primary care physician and advanced practice registered nurse were negligent since they did not provide the necessary healthcare services that meet their standards of practice. Apart from failing to make the necessary referrals, the nurse practitioner underperformed in her clinical duty. Besides, the physician did not bother meeting and examining the person to make a definitive diagnosis for early treatment. Even after ruling out gastritis, the nurse continued to treat this condition in addition to failing to examine any other cause of the gastrointestinal symptoms. Besides, no investigations were ordered, including the abdominal CT scan and colonoscopy, even after knowing that the person had a smoking and colon cancer history in the family. If the definitive diagnosis could have been made earlier enough, the prognosis of this condition could have been better. Besides, the negligence did not only cause immense suffering to the person but also resulted in the loss of life. Therefore, the jury should compel the defendants to compensate the plaintiff for the damages caused by the negligence in clinical practice.