Late that night, Mrs G woke up with chest pain, nausea, and vomiting. Her husband called 911, and she was transported to the hospital for an emergency coronary angiography. Unfortunately, the patient died shortly after arrival at the hospital.
Mr N was deeply upset when he heard the news about Mrs G. He felt guilty for not squeezing her in for an appointment the afternoon that she had called. He felt guilty for not advising her to go straight to the emergency department, but he really had thought it was a gastrointestinal issue. He felt even worse when he was notified that the practice was being sued by the patient’s husband for her wrongful death.
Mr N had never been involved in a lawsuit before and was extremely anxious about the proceedings, particularly his own deposition. Speaking to the lawyer assigned by the practice’s insurance company did not reassure him. Instead, he became even more frightened as he was told that what he said at the deposition would be used by the plaintiff to try to impeach his testimony at trial. Fortunately for Mr N, the case settled early in the discovery phase, prior to the taking of depositions. Both sides realized that settling was the better option.
In preparation for trial, both sides engage in the process called “discovery,” the formal process of exchanging information between the parties about the witnesses and information they plan to present at trial. The purpose of discovery is to allow the parties to learn what evidence may be presented at a trial and to avoid last-minute surprise evidence or witnesses when there would be no time for the other party to obtain contradictory evidence.
Discovery may include subpoenaing documents, requesting physical exams, and depositions. Depositions are oral statements, given out of court but under oath, by a person who is involved in the case. Depositions enable a party to preview what a witness will say at trial, and it provides that party a chance to impeach a witness’ credibility if he or she says something different at trial than they said during the deposition.
According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for women in the United States, responsible for about 1 in 4 deaths. Statistics indicate that almost two-thirds of women who die suddenly from coronary heart disease have no previous symptoms. Even when women do have symptoms, they often present differently than men do, and the symptoms are more likely to mimic common problems such as indigestion or anxiety, making heart disease sometimes tricky to diagnose.
Because heart disease in women can mimic other issues (such as heartburn), it is important to rule out myocardial infarction before arriving at a gastrointestinal-related diagnosis. Always consider cardiac risk factors such as family history, obesity, smoking, hypertension, and hyperlipidemia. In this particular case, the patient’s ECG indicating a left bundle branch block should have triggered further testing or referral to a cardiologist in light of her other symptoms. The patient’s diaphoresis might also have been a clue.
To further reduce the risks of misdiagnosing heart disease, consider developing a written chest pain protocol, and if possible, offer patients same-day appointments when they complain of continued symptoms for which they were recently seen. If this is not possible, send the patient directly to the emergency department and note this in the patient’s medical record.
Ms Latner, a former criminal defense attorney, is a freelance medical writer in Port Washington, NY.