An 18 Month-Old-Boy with Vomiting

In Bouncebacks, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks!, available at www.anadem.com and www.amazon.com. History of Present Illness John is a healthy 18-month-old boy. One morning shortly after Christmas, he awoke with cough and congestion. After breakfast, he had an episode of vomiting. Though his symptoms remained mild over the next 3 days, …

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A 14-Year-Old with Vomiting and Bumps on the Tongue

A 14-Year-Old with Vomiting and Bumps on the Tongue

In Bouncebacks, which appears periodically in JUCM, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks! Pediatrics, by Michael B. Weinstock, Kevin M. Klauer, Madeline Matar Joseph, and Gregory L. Henry, and is available at www.anadem.com and www.amazon.com. Can you spot the red flags without knowing the outcome? Introduction Note: The following is the actual …

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A 14-Year-Old with Vomiting and Bumps on the Tongue

Cynthia Romero, MD Introduction Note: The following is the actual documentation of the provider. Initial Visit Initial visit: 07/05/2013 Chief complaint: Vomiting, bumps on tongue History of Present Illness Patient is a 14-year-old male who presented with complaints of vomiting, dry mouth, and bumps on the tongue associated with trouble breathing and the feeling of heartburn. Nausea started last night with one episode of vomiting. Bumps developed over past week and are painful. No complaints …

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A 16-Week-Old Infant with Bloody Vomitus

A 16-Week-Old Infant with Bloody Vomitus

In Bouncebacks, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This case is from the book Bouncebacks! Pediatrics, by Michael B. Weinstock, Kevin M. Klauer, Madeline Matar Joseph, and Gregory L. Henry, and is available at www.anadem.com and www.amazon.com. Introduction A 16-week-old infant was brought by her parents to the emergency department (ED) of a children’s hospital. Note: The following is the actual documentation by the provider. Visit …

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A 34-Year-Old Man with Left Side Pain

A 34-Year-Old Man with Left Side Pain

In Bouncebacks, which appears periodically in JUCM, we provide the documentation of an actual patient encounter, discuss patient safety and risk-management principles, and then reveal the patient’s bounceback diagnosis. This month’s case reflects the actual documentation from an urgent care visit, and the patient’s bounceback the next day to the emergency department. Can you spot the red flags without knowing the outcome? MICHAEL B. WEINSTOCK, MD, and MIZUHO SPANGLER, DO Introduction Apicture tells a thousand …

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The Case of a 32-year-old Woman With Headache

The Case of a 32-year-old Woman With Headache

When an Uncommon—Potentially Catastrophic—Diagnosis Is Masked by a Common Complaint In Bouncebacks, which appears quarterly in JUCM, we provide documentation of an actual patient encounter, discuss patient safety and risk management principles, and then reveal the patient’s “bounceback” diagnosis. This Bouncebacks case is unique in that it also went to trial, excerpts from which are also presented. This case is adapted from the Bouncebacks! Medical and Legal (Anadem Publishing) by Michael B. Weinstock, MD, and …

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The Case of a 42-year-old Fireman with Shoulder Pain: When a Lifeline Becomes a Noose

There are some diagnoses that will be missed by nine out of 10 physicians; this is one of them. However, our goal is not to meet “Standard of Care” but to provide excellence in care: Take every patient at face value, without trying to guess their intentions for secondary gain. Ensure you are aware of the chief complaint stated to the staff in the urgent care center. Be an open book in your impression and …

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The Case of a 51-year-old Man with Back Pain

The Case of a 51-year-old Man with Back Pain

Most new third-year medical students can recite the “red flags” of back pain: extremes of age, fever, history of cancer, history of trauma, failure to improve after one month of therapy. Few would fail to consider metastatic disease in a 64-yearold woman with a history of breast cancer and new-onset low back pain, but what about the 51-year-old male without a significant past medical history?

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The Case of a 57-year-old Man with Heart Fluttering and Lightheadedness

The Case of a 57-year-old Man with Heart Fluttering and Lightheadedness

What happens when our patient so badly wants to be well that they talk us out of the correct diagnosis? “I think it is my anxiety” was the mantra accepted by the physician in this case. Though diagnoses are not always clear after the initial encounter, they are not up for negotiation. Patients have a vested interest, due to denial or human nature, in believing that nothing is seriously wrong with them. It can be …

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