Dialogue Volume 13 Issue 1 2017 | Page 55

discipline summaries prescribe antibiotics for a child with a “ bad ” pharyngitis , that is , with a fever and the presentation of this patient , because the presentation is more typical of strep as opposed to viral pharyngitis . For other cases that are not clear , a throat swab may be done and the patient given antibiotics as an outpatient prescription and notified if the throat swab is positive . The Committee is persuaded by the evidence of Dr . X that the treatment of pharyngitis as a strep infection is no more reliable than the toss of a coin , without a throat swab . With this particular issue , part of the reason that the Committee preferred Dr . X ’ s opinion was because of his association with the medical school , and the resultant need to keep up to date with his knowledge , as well as his years of being an ER physician , where he stated that this problem is common . The Committee found that Dr . Kamermans ’ clinical care was deficient in his treatment of pharyngitis with Amoxicillin rather than doing a throat swab to see if it was in fact indicated .
Patient # 2 Patient # 2 was an adult with rectal bleeding , rectal pain and a recent diagnosis of metastatic rectal cancer . Dr . Kamermans ’ documentation and care failed to meet the standard of practice . Dr . Kamermans failed to properly evaluate the rectal bleeding and failed to adequately manage the rectal pain . Dr . Kamermans displayed a lack of knowledge and judgment in his investigation and management of the patient and in his inability to outline his approach to this patient . Dr . X described the patient in his initial report as a middle-aged woman who came to the ER in May 2011 , complaining of rectal bleeding and pain . Another physician saw this patient on a subsequent visit to the ER about two weeks later . She had a recent diagnosis of rectal cancer with liver metastases and was being managed at a hospital in City C . The patient had an ostomy according to the medical record . Dr . Kamermans ’ note reads as follows , “ colonoscopy — rectal CA — going to City C Monday . Hgb 103 ”. The patient had blood work done including a complete blood count , chemistries and a clotting profile and Dr . X noted that there is no further information from Dr . Kamermans ’ charting to review except for the diagnosis on discharge of Rectal Pain NYD ( not yet diagnosed ). Both the College and the defence ’ s experts agreed that the documentation deficiencies included a lack of focus on the presenting illness , a past medical history , a review of systems , a physical examination , a differential diagnosis and a management plan . Dr . X testified that there is no documentation of Dr . Kamermans ’ thought process or approach to evaluation and treatment of this patient . The Committee is persuaded that Dr . Kamermans failed to maintain the standard of practice in this case in that the patient ’ s bleeding was not evaluated properly , nor was her pain treated adequately . No evidence points to a prescription being given for a stronger analgesic or that the patient was observed for a longer period of time after the analgesic was administered . Despite Dr . Kamermans ’ testimony that he was sensitive to palliative pain care issues , this was not borne out by any apparent consideration of what this patient may have needed when the Fentanyl action ceased . As well , the Committee finds that Dr . Kamermans displays a lack of knowledge and judgment in not investigating the rectal bleeding .
Patient # 3 Patient # 3 was an elderly patient with chest tightness , intermittent shortness of breath for the preceding 12 hours , heart rate of 162 and an implanted pacemaker / defibrillator . Dr . Kamermans diagnosed supraventricular tachycardia ( SVT ), rather than the correct diagnosis of ventricular tachycardia ( VT ), and prescribed Diltiazem , a medication which was contraindicated for this patient . When his treatment failed and the patient ’ s symptoms worsened , Dr . Kamermans called in a consultant who properly treated the patient .
Management of cardiac arrythmia Dr . X testified in his evidence-in-chief , Dr . Kamermans insisted that the use of Diltiazem was not contraindicated for use for this patient ’ s problem . Dr . Kamermans had a detailed page and a half typewritten note that the consultant completed the evening
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Issue 1 , 2017 Dialogue 55