Clinician Relies on Patient's Assumption, Overlooks Deadly Diagnosis

Physician overlooked myocardial infarction risk for an overweight patient who smoked
Physician overlooked myocardial infarction risk for an overweight patient who smoked

Dr. P was a 60-year old primary care physician with his own solo practice. He'd been in practice for himself for the past two decades, and had no shortage of patients. In fact, Dr. P was looking forward to scaling back his practice over the next decade as he prepared for retirement.

His practice at this point consisted largely of patients whom he had been seeing for years. Dr. P practiced medicine in the same small suburb in which he lived, and so many of his patients were neighbors and friends.

One afternoon, one of the physician's longtime patients, Mr. H, came in for an appointment. Mr. H was 53 years old and had a past medical history of gastroesophageal reflux disease (GERD) as well as chronic obstructive pulmonary disease (COPD), elevated cholesterol, borderline hypertension, and chronic back pain. Mr. H was also overweight – weighing in at 205 pounds with a height of 5'10” – a body mass index of 29.4. His blood pressure at this visit was 150/90.

“Doc,” said the patient, “my heartburn got a lot worse this week. It's really been bothering me. Can you give me something to help with this?”

Dr. P looked at the chart and verified that the patient was already taking 20 mg of omeprazole daily.

“Have you been taking the omeprazole as prescribed?” asked the physician.

“Yes,” replied the patient, “but this last week it just hasn't helped at all. I even took some Tums to see if that would help, but it didn't make a difference either.”

Dr. P thought that the patient's dietary habits might be the problem, and he gave Mr. H some strategies to avoid heartburn.

“Don't eat within two hours of going to bed,” advised the physician. “And you should avoid heavy meals, especially at night. Raising the head of your bed at night may help too. Have you quit smoking cigarettes yet?”

The patient looked embarrassed. “No,” he said, “not yet. They help with the stress. Hard habit to break, Doc, hard habit to break.”

“I know,” said the physician, “but smoking puts you at an increased risk for many other problems. Please consider trying to quit.”

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