Case Study: Mrs. Perdito

The clinician has not looked beyond the obvious immediate presenting complaint.

• He has not taken the time to pick up on subtle clues that the patient may be cognitively impaired (her inability to formulate a clear answer to why she is there).
• He uses leading questions.
• He has not included any general screening questions to check for cognitive impairment and certainly hasn’t used any standardized screening tools.
• He didn’t assess the patient’s understanding of her conditions and her treatment.

This patient was found wandering on the road near the hospital. She was taken to a different hospital where some effort was put toward finding her family members. Her daughter identified that this was not much different from her usual condition and that sometimes she just wandered off from home. She would have needed a safe way back home. They submit a letter of complaint to the first hospital.

The clinician sits down to get a better look at the patient and engages with her.

• He responds to subtle clues of confusion (uncertainty about why she is there) and initiates screening using some standardized components (test of short-term memory, orientation).
• He is aware that dementia is common in older ED patients and is careful to include it as part of his differential diagnosis.

It may have taken a bit longer, but the outcome was significantly different and an early return to ED was avoided.

This patient’s daughter was contacted by ED staff. She came and said that there wasn’t much different from usual with her mother and took her home. She expressed gratitude for looking after her mother so well.