Page 57 - Hospitalists - Risks When You're the Doctor in the House (Part One)

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

to normal sinus rhythm during the TEE. Because of Mr.

Richardson’s atrial fibrillation, Dr. Ford ordered intravenous
amiodarone, followed by oral amiodarone, loading at

400 mg po tid. (amiodarone is an antiarrhythmic agent
that is often sold under the brand names of Cordarone

and Pacerone.) Dr. Ford also prescribed Pradaxa 150 mg
po bid as an anticoagulant agent. Mr. Richardson was

discharged from the hospital by a hospitalist rather than by
Dr. Ford. At discharge, the loading dosage of amiodarone

400 mg po tid was continued with no recommended
dosing reduction, with a scheduled follow-up office visit

four weeks later.

At the follow-up visit, Dr. Ford documented in his office
note that Mr. Richardson was taking amiodarone 200

mg po bid, when in fact, Mr. Richardson was still taking
the loading dosage of 400 mg po tid. The 200 mg po

bid dosage is what Dr. Ford would have anticipated the
discharge orders to contain, but he did not review the

discharge summary and instead assumed the discharging
physician had appropriately reduced the dosage. Mr.

Richardson described symptoms of increasing shortness
of breath and dizziness at that visit. Laboratory follow-

up for amiodarone toxicity was planned for three months
later, with anticipated thyroid function tests, liver function

tests, and pulmonary function tests at that time. Despite
these new complaints, Dr. Ford did not review the dosage

of the amiodarone, nor did he otherwise review the dosage
with Mr. Richardson.

Mr. Richardson had several office visits with various
healthcare providers (who were not sued) over the next

few months, with continuing complaints of weakness,

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