Diagnostic Errors in the COVID-19 Era

Editor's note: Some details have been changed to protect the patient's identity.

Jaya Mallidi, MD, MHS

It was an unusually quiet Saturday afternoon on call. I was sipping coffee and leisurely reading that day's echocardiograms. On one, ordered for an indication of "dyspnea," there was a moderate-sized pericardial effusion without tamponade physiology. I called the ordering hospitalist to tell him the results. He mentioned that the patient was admitted the previous day as a "COVID rule-out." Mr Gonzales was a 55-year-old man with progressively worsening exertional shortness of breath and cough over the previous 2 weeks. A chest x-ray showed cardiomegaly, concerning for pericardial effusion. His vital signs were stable and he was admitted with a diagnosis of viral pericarditis and high suspicion for COVID-19. Rapid SARS-CoV-2 testing was negative, but another test was ordered given the high clinical suspicion.

The Patient in Person vs the EHR

I called the lab for the second COVID-19 test result but was told that it would not be available for several hours. With not much clinical activity going on, I decided to go see Mr Gonzales. I donned the necessary personal protective equipment and entered his room.

Mr Gonzales was propped up in the bed. A yellow mask covered his mouth but stopped short of covering his nostrils.