A 42-year-old male comes to the emergency department with left lower quadrant and suprapubic abdominal pain which has become progressively worse over the prior two days. The day of presentation he noted mild chills prompting him to come in for evaluation.
The patient states that he has had nearly identical symptoms twice in the past six years. On both occasions he was evaluated by a surgeon in the office, lab testing and a CT of the abdomen were performed, and diverticulitis was diagnosed. In both previous cases, the patient was given a two-week course of oral ciprofloxacin and metronidazole and made an uneventful recovery. He attempted to see the same surgeon for this episode of pain, but the surgeon had closed his practice and moved out of state. The patient has no other medical history and takes no other medications.
On examination, the patient has normal vital signs and is afebrile. His abdomen is moderately tender to palpation in the left lower quadrant and suprapubic region. There is minor localized left lower quadrant rebound tenderness present. Rectal examination is normal. No other abnormalities are present on physical examination.
The patient does not want lab testing or radiographic studies performed. Instead, he requests a prescription for two weeks of ciprofloxacin and metronidazole. He also requests the name of an on-call surgeon with whom he can follow up as an outpatient.
After some discussion, the patient agrees to a CBC and urinalysis in the emergency department, which are both normal. A check of the old medical records confirms the patient’s history of sigmoid diverticulitis.
The physician then discharges the patient with prescriptions for antibiotics and pain medications, along with a follow-up appointment at the on-call surgeon’s office in 48 hours. The patient also receives strict instructions to return to the emergency department if he gets worse.
Without knowing the patient’s outcome, did the emergency physician’s actions meet the standard of care?
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