When health care doesn't work

[Guest guest]

I try to give other health care professionals the benefit of the doubt, so does

anyone have a generous explanation for the following scenario?

A new patient came to me after being admitted to an out-of-town hospital with

renal failure and syncope associated with subarachnoid hemorrhage. Was seen by

hospitalist and nephrologist. They felt everything was due to NSAID and ACE-I

use, changed him to HCTZ, and discharged him.

They did not get previous records to know that he had been on ACE-I for years

and had lab 2 weeks prior to admission showing normal renal function.

There is no record of urinalysis being done, and the nephrologist will not

return my call asking for a urinalysis result. Every nephrologist I know does a

u/a for everything -- including left pinky toe pain.

They also told the patient he should change PCP to someone younger because his

doctor caused this problem -- but his monitoring had been very thorough.

Patient came to me with continued azotemia that only resolved when I stopped his

HCTZ. But now the question is -- was this ATN or prerenal? No testing was done

at the time to give me any info.

Another symptom of the speed of health care?

Haresch