Dismissive Healthcare Encounter in Patient with History of Alcoholic Cirrhosis
Case at a Glance
A 50-year-old female with a history of alcoholic cirrhosis (8 years sober) presented to a low-income clinic for routine women's wellness care but was inappropriately dismissed when expressing concerns about new abdominal swelling and discomfort in the liver region.
Patient's Story
The patient, who maintains sobriety for 8 years following hospitalization for alcoholic cirrhosis, sought routine gynecological care at a community health clinic. She reported new-onset swelling in the right upper quadrant area with associated discomfort, describing the swelling as football-sized and persistent. The patient expressed appropriate concern given her medical history and demonstrated health consciousness by avoiding hepatotoxic substances. She became tearful when her concerns were dismissed, which she attributed to anxiety about her liver condition rather than emotional instability.
Initial Assessment
The nurse practitioner reviewed recent laboratory results showing bilirubin level of 0.3 mg/dL (within normal limits of 0.1-1.2 mg/dL). Physical examination details were not thoroughly documented. The provider focused solely on the normal bilirubin result without comprehensive evaluation of liver function or physical examination of the reported swelling.
The Diagnostic Journey
The encounter was prematurely terminated when the provider dismissed the patient's concerns as 'paranoid' and 'hysterical.' No additional diagnostic workup was ordered despite the patient's significant medical history and new physical symptoms. The provider suggested emergency department evaluation but discouraged it by stating they would provide the same dismissive response.
Final Diagnosis
No formal diagnosis was established. The provider concluded there was 'nothing wrong' based solely on normal bilirubin levels, failing to consider other causes of hepatic or abdominal swelling in a patient with known cirrhosis.
Treatment Plan
The provider inappropriately recommended psychiatric evaluation and medication rather than addressing the patient's physical concerns. No follow-up liver function monitoring, imaging studies, or specialist referral was arranged despite the patient's high-risk status.
Outcome and Follow-up
The patient left the encounter feeling dismissed and reluctant to seek further medical care. Multiple healthcare professionals in consultation recommended seeking evaluation from a physician rather than mid-level provider, obtaining comprehensive liver function panel including ALT, AST, alkaline phosphatase, albumin, and GGT, and considering abdominal imaging. The case highlights the need for appropriate triage of patients with complex medical histories and the importance of compassionate, thorough evaluation rather than dismissive care.