Specific Medicolegal Issues

Appendicitis is a leading cause of litigation against emergency physicians. Appendicitis carries a high medicolegal risk because it is difficult to diagnose and there are no definitive diagnostic studies. Several features common to these malpractice cases have been identified. 32 Misdiagnosis of appendicitis more often occurred in patients who presented atypically and who did not receive comprehensive assessments, including rectal examinations. These patients were often given intramuscular narcotics for analgesia, given a diagnosis of gastroenteritis (without manifesting many of the typical symptoms), and discharged without appropriate follow-up care. Based on these considerations, the prudent emergency physician should maintain a high index of suspicion for appendicitis, perform complete examinations, avoid narcotics for unclear diagnoses, use the term nonspecific abdominal pain as a diagnosis rather than inappropriate labels for unclear causes, and arrange close follow-up for patients without a clear diagnosis. It is also imperative that all such observations, interventions, and thought processes be clearly documented in the record both to facilitate further care of the patient and to protect against potential litigation.

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