Just wrapping up my MS3 year on an IM rotation. Had a patient without a history of CKD admitted recently for new heart failure and AKI, now needing dialysis. I did some intense chart sleuthing and found they saw their primary care PA a couple days before admission complaining of worsening ankle and leg swelling, fatigue, shortness of breath, orthopnea, PND, cough, and lightheadedness. Drew labs at the appointment, including BNP, which was ~1,000. All this was clearly recorded in the PA’s note, but no comment on the BNP. Patient was taken off their low dose amlodipine due to the LE swelling and started on 200mg metoprolol for their HTN. Few days pass and all symptoms significantly worse, accompanied by new oliguria, and found to have AKI due to ATN.
This was obvious decompensated heart failure, and Step 1 couldn’t have come up with a more typical presentation. The last thing they needed was a BB. I feel terrible for this patient, and I can’t stop thinking about how all of this could have been prevented. I’m trying to get over it, but I also can’t help feeling a little angry that this patient is suffering for a careless mistake.
I know I’ll make and see many mistakes in the future, so I guess my question is how do you get over mistakes in your own and others’ management? Obviously not as a med student, but do you privately reach out to colleagues who you think may have made a mistake? Also, I know the Step 1 answer to this, but do you always tell the patients?
As a related question, does it ever get easier to distance yourself from the suffering of your patients? Maybe this situation is just really getting to me, but I’ve caught myself almost feeling bad for enjoying myself when not on duty thinking about “my” patients still in the hospital.
Many thanks for any thoughts on this.
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