When a Diagnosis Doesn’t Make Sense

Mistakes happen in healthcare, it doesn’t take an expert to tell you that.  I always say that you can tell a lot from a medication list.  If someone is on 5 blood pressure medications, it probably tells you that they have high blood pressure.  If someone is on two antipsychotics, I’m going to guess they have had some significant mental health issues. Below is a case where a diagnosis doesn’t make sense.

A 68 year old female was admitted with an extensive past medical history.  Current diagnosis include:

  • Coronary Artery Disease
  • Hyperlipidemia
  • Hypertension
  • Hypothyroidism
  • Depression
  • Anxiety
  • Overactive bladder
  • Glaucoma
  • Anemia
  • Constipation
  • Osteoarthritis

The medication list includes:

  • Aspirin
  • Atorvastatin
  • Lisinopril
  • Hydrochlorothiazide
  • Hydralazine
  • Sertraline
  • Tolterodine
  • Travatan
  • Timolol
  • Iron supplement
  • Senna
  • Tramadol
  • Acetaminophen

Looking at the diagnosis and the medication list, did you catch what might be potentially missing?  In this scenario, the patient was recently discharged from the hospital (had a UTI) and has been lethargic and depressed in the weeks following discharge.  Sertraline was increased about a week following hospitalization and at the 1 month mark following discharge, the lethargy and depressive symptoms have not improved.

What doesn’t make sense and needs to be investigated in this scenario is TSH.  This patient has a diagnosis of hypothyroidism and is not currently being treated.  When the TSH was ordered, the result came back at 52 and levothyroxine was initiated.

It is so important to dig into a diagnosis that doesn’t make sense!

Enjoy the blog?  Make sure to check out my 30 medication mistakes, a free 6 page PDF full of clinical pharmacy pearls from my personal experience!

5 Comments

  1. Joy

    You are doing a great job Doc!

    Reply
  2. Jones

    Eric, thank you for sharing your experience.You are doing a great job.But what is the best way of pointing error of diagnosis to a physician?

    Reply
    • Eric Christianson

      No doubt that’s a tough one, as diagnosing is not really in my scope of practice, so I usually try to relate it to medications in someway, and always pose it as a question.

      Reply
  3. Cosmos

    Excellent post. Keep up the good work

    Reply
  4. Samantha

    I always look at a patients PMH and current med history and make sure that for every diagnosis there is a subsequent treatment and if there are any discrepancies I will question the patient/Doctor. The same goes for the opposite…if a patient is on a medication for which there is no indication, I will question that as well. I will always always always review and review just to make sure all my “I’s are dotted and T’s crossed” before that patient leaves my care. At the very least the doctor should understand we are just doing our job….not telling them how to do their job. We are after all, the medication experts! That’s why it is so important for Doctors to work together to make sure our patients are getting the best care! Great post!

    Reply

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Written By Eric Christianson

January 27, 2016

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