This case study revolves around a 60-year-old patient who experienced difficulty walking, syncope, and dizziness. These symptoms included lower extremity pain diagnosed as claudication.
The patient was referred to physical therapy but continued to experience worsening symptoms. They also included ongoing complaints of lower back pain, stiffness, pain in the lumbar region, and gait imbalance.
Despite these symptoms, the patient’s primary care physician (PCP) allegedly did not consider a differential diagnosis. There was no referral to specialists or diagnostic testing performed for an extended period of time.
Eventually, after many months of suffering, the patient was diagnosed with cervical myelopathy with severe cord compression in the cervical spine. They underwent multilevel cervical decompression and fusion. This case study examines the PCP’s potential liability in this delayed diagnosis scenario.
Questions to the Family Medicine expert and their responses
Please describe your experience evaluating and treating patients with lower extremity pain complaints in a primary care setting.
As a family physician actively practicing for 26 years, I frequently encounter patients complaining of lower extremity pain multiple times a week. Additionally, difficulty walking, syncope, and dizziness are all common complaints I deal with regularly.
Care for these patients requires careful history taking, a physical examination, lab testing, and diagnostic imaging. They often require specialty consultation if the diagnosis is unclear or if treatment falls outside the primary care provider’s scope.
What differential diagnosis should be considered in this case?
The differential diagnosis in this case could include conditions such as lumbar radiculopathy, peripheral neuropathy, stroke, multiple sclerosis, various cancers including multiple myeloma and lymphoma, peripheral vascular disease among others depending on the details of the case.
About the expert
This expert is a seasoned family medicine practitioner with over two decades of experience. They have an extensive educational background, including a BS and MD from a prestigious Ivy League university and an MPH from a renowned school of public health. Currently, they're working as an attending family physician in New York while also serving as a clinical assistant professor of family medicine.
About the author