In Chest Pain & Medical Malpractice, medical malpractice expert witness Barry Gustin, M.D. writes:
When a patient comes to an Emergency Room complaining of chest pain, the Emergency Physician is faced with complex and difficult decisions. The physician must decide whether a major diagnostic or therapeutic intervention should be used and then must decide whether the patient is to be admitted or sent home. choosing wrong may result in catastrophic consequences for the patient making the evaluation of chest pain on of the most challenging and studied presenting medical problems, from both the clinical and risk management point of view.
For attorneys involved in litigation concerning misdiagnosed chest pain, it is essential that the complexity of its evaluation be understood and appreciated.
Physicians work form a differential diagnosis by weighing the frequency of specific diagnoses in different patient groups, associating clinical findings with common illnesses, and applying available ancillary tests to diagnose and triage adults with acute chest pain. This process, however, is extremely difficult in a brief ER visit with limited access to historical information. The ERMD will attempt to quickly establish and document an adequate database, estimate the rusk of life-threatening disease, use history and physical examination to evaluate the risk analysis, determine the role and interpretation of available ancillary tests, and then document the reasoning viewed for clinical decisions regarding disposition of therapy.