Mock 11

Patient Prompts

• The son is visibly upset and demands an explanation: "How could the doctors miss such an important finding? My mother could have been spared this second fall!"
• He expresses concern about his mother’s increased pain and potential for long-term impact on her mobility.

Scenario Clinchers

• The radiologist's review confirmed a missed fracture in the initial X-rays, which was only identified after a second fall led to a CT scan.
• The patient's pain has intensified, and there is now a clear need for a different management approach, possibly surgical intervention.

Patient Concerns

• The son is anxious about his mother’s well-being, the quality of care received, and the implications of the missed diagnosis on her overall health and recovery.
• He is looking for reassurance that his mother will receive appropriate care and wants to ensure that such errors are not repeated.

Clinchers and Important Points for the Doctors

• Acknowledge the oversight and express empathy for the patient's and family's distress.
• Ensure a thorough clinical reassessment of the patient, considering the new findings and the impact of the second fall.
• Transparent communication is crucial, involving discussing the error, how it occurred, the implications for the patient’s health, and the steps being taken to manage the situation and prevent future occurrences.

What Is Expected from the Doctor

• Provide a clear, empathetic explanation of the missed finding on the initial X-rays and the subsequent steps to correct the issue.
• Discuss the updated management plan, including any potential surgical intervention, pain management, and rehabilitation.
• Address the son's concerns directly, offering reassurance about the patient’s care and discussing measures to prevent such incidents in the future.

Red Flags

• Increased pain and potential complications arising from the delayed diagnosis, such as worsening of the fracture, increased risk of surgery, or prolonged rehabilitation.
• The emotional distress and loss of trust by the patient and family, which need to be managed carefully to maintain a therapeutic relationship.

Actions Doctor Should Do

• Immediate reassessment of the patient’s pain and mobility status, adjustment of pain management, and expedited orthopedic consultation.
• Implement an incident report regarding the missed diagnosis, contributing to quality improvement and preventing similar errors.
• Facilitate a meeting with the patient’s son, possibly involving patient advocacy or hospital administration, to discuss the event transparently and outline the steps being taken.

Referral Needs

• Orthopedic referral for the assessment of the hip fracture and consideration of surgical versus conservative management.
• Consider involving a geriatric specialist or a multidisciplinary team to address the broader implications of the fall and fracture, including future fall prevention.

Reason for Referral

• The orthopedic consultation is crucial for the immediate management of the hip fracture and to plan the appropriate intervention, which might include surgery or specific conservative management.
• Involving a multidisciplinary team can help address all aspects of the patient’s care, ensuring a holistic approach to her recovery and future well-being.