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A primary care physician referred a case to the hospital medicine patient safety committee for evaluation of excessive testing and medical management involving a patient who had been hospitalized. The patient was a 54-year-old woman with advanced multiple sclerosis who was bed-bound and nonverbal and lived at home with a full-time caregiver. Her mother was her surrogate decision maker and had stated that the patient would not want aggressive medical procedures or cardiopulmonary resuscitation but would want some reversible illnesses treated. The patient was admitted to the medical teaching service at the hospital where she received all of her care after her caregiver noted that she had become increasingly somnolent during the previous day. On presentation, the patient had a fever, tachycardia, leukocytosis (20 × 103/μL), markedly elevated liver function findings, and computed tomography (CT) of the abdomen and pelvis showing cholecystitis. Antibiotic treatment was initiated and the surgery service was consulted.
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Corresponding Author: Christopher Moriates, MD, Dell Medical School, University of Texas at Austin, 1501 Red River Dr, Health Learning Bldg, Room 2.323, Austin, TX 78712 (email@example.com).
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Moriates reports receipt of textbook royalties from McGraw-Hill. No other disclosures were reported.
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