It’s not unusual for patients or their families to ask for (or even try to demand) prescriptions or tests. Occasionally, a patient may be correct in his/her idea of what should be prescribed or ordered. In this month’s case we look at a situation where a patient and his family had one idea about diagnosis/treatment, and the clinicians had another. Complicating the case was the fact that the two clinicians ended up with conflicting stories by the time the case went to trial.

The patient, Mr. C, was a 55-year old steel welder who was moderately overweight and had Type 2 diabetes. While at work one day Mr. C tripped over a metal girder and fell, landing hard on his right hip. Despite his discomfort, Mr. C finished his shift at work. At home he took an ibuprofen for the pain and went to bed. He awoke the next morning in terrible pain, and his wife took him to the emergency department of the local hospital where x-rays were taken. The hospital physician notified Mr. C that the x-rays were negative, but that he would prescribe some pain medication. He gave Mr. C a prescription for hydrocodone and discharged him.

Over the next few days, Mr. C’s pain increased, and he developed other symptoms, including shortness of breath, lack of appetite, and pallor. His wife became increasingly alarmed – Mr. C normally was vigorous and had a robust appetite. After three days had passed, she decided to take him to the local walk-in clinic.

The clinic was staffed with several clinicians, including Mr. P, a physician assistant, and Dr. L, the supervising physician. Mr. P, 38, was on duty that day and he introduced himself to Mr. C and his wife. Mrs. C launched into the story of her husband’s fall, how he’d landed on his hip and had been in pain since. “He doesn’t seem to be getting better,” said Mrs. C. “In fact, he complains about the pain more and more.” Mr. C nodded in agreement.

The PA conducted a brief examination of the patient and diagnosed him as suffering from a muscle strain. He advised Mr. C to rest and take ibuprofen.