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Some test questions use a case history with facts and circumstances
to reinforce legal principles that operate in clinical practice
situations.
A worker is struck in the lower chest area by a heavy object. Your
examination is cursory and you do not order any laboratory tests.
Chest x-rays are taken. You assure him that nothing is broken and
prescribe analgesic medication. The following morning, the patient
complains of shoulder and mid-dorsal pain, reporting that he "spit
up" blood during the night. You suspect that he is malingering and
therefore do not limit his activities. Later at work, he collapses
because of an intraperitoneal hemorrhage secondary to laceration
of the liver. The patient sues you for negligent misdiagnosis.
A physician has a duty to formulate a reasonable differential diagnosis
through careful collection and selection of clinical data, and then
to appropriately analyze the clinical findings to arrive at a diagnosis.
Failure to collect salient data indicates that a physician lacks
sufficient knowledge to treat the condition. In this case, diagnostic
studies were indicated to rule out internal injury, especially with
complaints of hemoptysis and shoulder pain. The physician's conclusion
that the patient was malingering suggests that this diagnosis was
not the product of competent differential diagnosis. Failure to
properly weigh these clinical facts and circumstances casts doubt
on the physician's clinical judgment and competence.
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