It happened to my father
An unexplained blood pressure of 89/58 is just "dehydration", according to the NP that took care of this person's father.
In retrospect my family and I should've have suspected something had been off with my dad for the past month, and with even better hindsight that year for him was full of odd symptoms popping up.
While his diagnosis is still an unknown, and the illness has seemed to vanish, that doesn't excuse what happened in the crucial time period where he acutely worsened.
As a medical student myself I was vividly aware of my dad's condition deteriorating over the week, but while I was at work that Wednesday my father had become incredibly fatigued and started falling continuously. His tremors were much worse than usual, he could barely stand. So my mother, who came home early by nothing other than coincidence, took him to an urgent care. When I had returned home they were already back from the visit but texted me about the visit.
As usual they asked me to take a look at the results sheet from what was found at the urgent care. First thing I noticed is that the note was written by a NP. At least it listed everything that was done, but I couldn't quite believe what the practitioner had decided was the diagnosis.
To give some context, at the time my father had a long history of having Stage 2 Hypertension, Crohn's disease w/ rheumatoid arthritis, mild aortic regurgitation, and was a two year-long type 2 diabetic. For two days he hadn't been using his antihypertensive medications because he had felt too weak on them, and he thought it may be his blood sugar being low so that morning he didn't take his antiglycemic medication either. On the note, the NP notes all of these things, and provided some basic lab values. Blood glucose was normal, UA was normal, all vitals except one were normal. His blood pressure was 89/58.
With this information the NP gladly diagnosed my dad with a simply case of "dehydration" and sent him home. No differential provided. No urgency behind it, just "drink water and you'll be fine". My parents figured the NP discussed it with the physician there, but when asking them about the visit, my parents never once saw anyone except the NP.
Never mind the fact that this man has been stage 2 hypertension for most of his life, or that he is not even taking his medications because he is so fatigued. Let's also forget the completely normal urinalysis, and forgetting to test for any sort of physical exam findings that might support such severe hypotension (didn't even test for orthostatic blood pressure properly).
When I saw this I highlighted the BP reading and sent my dad to his GP who immediately was outraged at the urgent care, but by the time he got to the GP all the symptoms had resolved.
That Friday would be one of the scariest of my life as I found my dad in a state that looked like a mix between a stroke and meningitis put together, with every symptom infinitely worse than before. I called my GP, and he said to get him to the ED as quick as humanly possible, so I called EMS.
To this day no one knows what happened, but I am damn lucky I found him that way and got him to the hospital before he had seriously hurt himself falling again. I realize not even the GP or the specialists could figure out what happened, but they aren't sending people home with BP levels seen in critical patients.
Mid-levels are not recognizing where their limits are, and it could have cost my dad his life.