Fast Healer
Posted on 18. Mar, 2010 in Case Reports
Case Synopsis
Irene
Back in September 21, 1996, Dr. Swift saw Irene, an 18 year old female, at the urgent care clinic complaining of constipation, vomiting, weight loss, and poor appetite. 
This had been going on for 4-6 months. She weighed only 74 pounds and was hypotensive at 77/45 with a pulse of only 43.
Dr. Swift noted that Irene was “extremely thin” but otherwise normal. He ordered her an EKG, which showed a heart rate of only 34. Blood tests showed her sodium level remarkably low at 125. Dr. Swift’s assessment: “profound weight loss, anemia, dilutional hyponatremia, and anorexia.” And for his treatment plan, he prescribed Compazine (an anti-nausea medication), Metamucil, and advised her to stop taking in “free water.” Instead of admitting her in that serious condition, he sent her home to see him in a week.
April
A week later, Dr. Swift saw another patient, April, who was 38 years old. She had been having stomach discomfort for approximately one month, going from right to left. Without much further workup, Dr. Swift described the problem as “food intolerance” and prescribed her Metamucil.
These types of scenarios happened over and over again, with Metamucil as one of his “drugs of choice,” along with failing to take proper medical histories.
Olga
On September 28, 1996, Dr. Swift saw another patient, Olga. She was 44 years old and was suffering from left sided chest pain and back pressure for two days. She reported that she had a history of hypothyroidism. When Dr. Swift examined her, he noted that she had enlarged thyroids.
He ordered a chest x-ray among other tests, which returned normal. He assessed the patient with “history of hypothyroidism [or maybe] Graves” and ordered more labs with the Olga to return in two weeks–completely ignoring Olga’s complaint of chest and back pressure or performing any tests to check for a heart attack.
Claudia
On October 1, 1996, Claudia, a 45 year old female, came to the urgent care complaining of high fever, cough, night sweats, and “vaginal yellow discharge.”
Dr. Swift examined Claudia and ordered a chest x-ray which revealed “diffuse bilateral infiltrates with possible areas of cavitation in the upper lobes.”
That sounded like tuberculosis, and sure enough, Dr. Swift’s assessment was “possible pulmonary tuberculosis”…and again without further workup, he sent her home with several antibiotics. Note that if it was indeed pulmonary tuberculosis, Claudia may have needed hospitalization instead of spreading the disease out in the public.
Case Outcome
In the medical board report, they charge Dr. Swift for gross negligence, repeated negligent acts, and incompetence for failing to “diagnose, treat or follow 9 patients with various illnesses.”
Dr. Swift’s license was revoked, but stayed with 30 months probation with terms and conditions.
Analysis by Lyssa
This case was slightly different to read because, unlike most of our previous stories, the case files do not actually follow up on the patients. We aren’t told what happened to them after seeing Dr. Swift. In fact, he could have been completely correct in each and every one of the 9 patients that he was cited for.
Actually, the sticking point of this case is not about whether Dr. Swift was right or not, but about how he went about diagnosing and treating them. Time and again, he seemingly went with his first instinct rather than to carefully consider all the possibilities. Perhaps nothing serious happened, but that would be because of sheer luck.
It is possible that Dr. Swift was stretched thin and had a lot of patients to see in the ER. Regardless, it is a doctor’s duty to think of all the possible differential diagnoses, but instead it felt like Dr. Swift was performing triage. And what was he thinking, sending an anorexic home and releasing a potential TB patient out into the public?
Perhaps Dr. Swift was a smart doctor and could tell what he was dealing with, but it is obvious that he was not a responsible one. Procedures are put in place for a reason, and he is only lucky that nothing horrible happened (that was recorded here). However, I chalk this one up to ineptitude and not lack of ethics.
| Score |
|---|
| 5 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 4 | 7 | 9 | 3 | 2 |
Response by Jessie
I understand that urgent care clinics can be just as busy as an emergency room. I know that a lot of people who have little or no health care go to urgent cares to receive treatment. What I don’t understand is how a doctor who works in one could completely disregard and misdiagnose so many people. I have had to take my children to urgent care when they couldn’t be seen by their pediatrician. Hearing this story scares me.
The potential harm in all of these cases astounds me. I disagree with Lyssa in that I believe proper ethical conduct was not followed. They all seem to be cases where he should have referred them to the ER, not sending them home with little or no follow up — it certainly felt he did not care too much about the patients.
I don’t like the probation of 30 months, as it just seems much too little. Even with the conditions stated in the case files, I think his incompetence in nine cases should be enough for his license to be revoked or at least with more stringent conditions. All of the cases listed had the possibility of being life threatening. As Lyssa said, it’s pure luck they didn’t actually die.
It’s the doctor’s job and responsibility to make sure that a patient receives the right treatment, not cursory glances while being rushed home with Metamucil.
| Score |
|---|
| 6.8 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 6 | 6 | 9 | 6 | 7 |
Response by Marc
When I read this case, my mind pulls up an image of a super happy, vibrant character bouncing from patient to patient. “How do you do?” while grinning ear to ear. “Got stomach pains? No problem! Take Metamucil, helps make you regular too!”
Being honest, don’t we actually gravitate towards such individuals? The happy-go-lucky life-is-wonderful you’re-gonna-be-fine doctors are fun. They make going to the doctors less stressful and intimidating. They liven the place and when you leave the ER, you think to yourself “that was one cool smart doctor.”
No? You don’t agree with me? I see it all the time. Every week I see ads such as “get flat abs with this new techno-gizmo! NO SURGERY! INSTANT! Lunch hour magic!” I see that no different than “take Metamucil for your appendicitis.”
As patients, we need to stop being enticed by coolness and seek honest, serious answers.
| Score |
|---|
| 5.8 |
| Damage | Anger | Ineptitude | Shock | Ethics |
|---|---|---|---|---|
| 5 | 4 | 9 | 3 | 8 |
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Marla
Mar 18th, 2010
I’m in awe, shock and somewhat dismayed at the attitude of Dr. Swift. I realize doctors have only so much time to spend with each patient due to DRGs and insurance requirements for reimbursement. However, sometimes you need to put that aside and provide proper care for each individual. Metamucil for anorexia and food intolerance? Really? Seriously? Come on. As patients, we have to learn to demand the best treatment and a listening ear when we’re seeking treatment. Demand to know what the tests mean, what they’re meant to find and what exactly with the prescribed treatment will do. And don’t be afraid to correct the doctor if he makes a mistake. Run away, “SWIFTLY” from accepting all treatment plans because “THE DOCTOR ORDERED IT AND THE DOCTOR IS ALWAYS RIGHT.” No, the doctor is a human being as well and is NOT always right. Call them on it. That’s the only way you’ll receive the best treatment according to your symptoms. Did the patient with TB symptoms ask what the antibiotics were for? Did each patient receive proper teaching (verbal and written) on their diagnosis and treatments? I doubt it. These mistakes made by doctors who must go before the board should have their licenses revoked, not suspended, when they are horrible and negligent. Suspension? Really? Seriously? That’s just a delay in negligence if you ask me. Did Dr. Swift learn his lesson after 30 months? If the stay is still in progress, will he learn his lesson? Really? Seriously?
RachLv
Mar 19th, 2010
The patients obviously didn’t die! Otherwise we would have heard about it. What’s wrong with him being right? Seems like he knew what he was doing and was probably stretched so thin. Blame the system.
Marla
Mar 19th, 2010
There’s nothing wrong with the doctor being right. Yes, I do blame the system and I’m sure doctors do as well. Still, that’s not a reason to neglect other symptoms that are important to the case, prescribe something only for lesser symptoms then ask them to follow up in a week or so. No, they didn’t die……at THAT time. But, some of these symptoms are chronic, terminal or fatal if not dealt with immediately. And in my opinion, he DIDN’T know what he was doing. He didn’t deal with obvious symptoms of TB nor symptoms of cardiac dysfunction (low sodium level, heart rate of 34, chest pain, back pressure). What’s that about?
What_The_Heck
Mar 28th, 2010
Ahh please, I hate going to see the doctor only to have spent more time in the waiting room than actually being seen and treated by the doctor!