Page 34 - Hospitalists - Risks When You're the Doctor in the House (Part Two)

SVMIC Hospitalists - Risks When You’re the Doctor in the House

C A S E S T U DY

A 58-year-old male patient was referred to a general

surgeon by his PCP for a skin abscess. The patient had a
low-grade fever of 101 degrees and redness with painful

tenderness around the abscess. The patient had been
treating the abscess with warm Epsom salt soaks. The

surgeon recommended an incision and drainage which
was performed that day in the office. The surgeon

prescribed penicillin and sent the patient home. That
occurred on Friday morning, and the surgeon was leaving

for an extended vacation at noon the same day. The
prescription was filled at a local pharmacy, and the patient

took an initial dose. Afterward, the patient’s wife returned
to work, leaving the patient home to rest. Approximately

two to three hours later, she returned home to check on
her husband. The patient had a high fever and uncontrolled

chills. The patient’s wife took him to the emergency
department where labs were drawn, including blood

cultures, and the medical record noted a temperature of
104.7 degrees. He was given IV antibiotics and IV fluids

over a period of seven hours. When the fever did not
resolve, the patient was admitted to the on-call surgical

service and placed under the care of a hospitalist. The
patient was diagnosed with sepsis and remained in the

hospital for four days. His final blood culture returned with
the identified bacteria, but the sensitivity results had not

returned. The hospitalist discharged the patient on
Clindamycin, “as this usually covers the bacteria”. The

patient picked up the prescription on the way home from
the hospital. About a week later, the patient’s temperature

was elevated, and he called his PCP. The PCP obtained

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