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