THE ART OF HISTORY TAKING

DR SREEJOY PATNAIK

SHANTI MEMORIAL HOSPITAL

CUTTACK

5TH JANUARY 2013

2013

TO ALL OF MY COLLEAGUES

• Nobody can teach you, unless you try to learn

• A teacher cannot teach u all the time, he can expose your ignorance only.

• Don’t expect too much from a teacher because his knowledge is limited.

• Rather, try to learn from the books under the guidance of your teacher.

• Never compromise quality in learning. As the future( treating & teaching ) will be in your hand.

• We may not be excellent , but have the scope to excel.

INTRODUCTION

• History taking skills is very much essential in medical curriculum.

• Objectively being tested in formal exams

• Forms the basis of reaching a correct diagnosis

• Often ignored/ proper emphasis is not applied by many of us.

IMPORTANCE

• In HT we evaluate the feelings of a person.

• Sometimes we evaluate the Gestures when a pt. is unable to express his feelings.

• Is there any equipment developed so far to measure or assess the feelings & gestures of man (patient)?

• Therefore HT & PE forms the foremost aspect of Medical Science.

• It is considered as an Art.

• HT –a process to assess feelings.

• Feelings- symptoms of diff. diseases.

• - cannot be quantitated nor expressed in sc. terms

• Scientific understanding of disease- body changes in terms of changes in anatomy & physiology.

• HT- assess bodily changes & its affect on mind.

• Non – verbal communications

• Body language- no physical ailment, but symptomatic.

Importance of History Taking

• Obtaining an accurate history is the critical first step in determining the etiology of a patient's problem.

• A large percentage of the time ) 70%), you will actually be able make a diagnosis based on the history alone.

Introduce yourself. • Note – never forget the patient names• Be friendly and relaxed with the Patient.•Respect Patient Confidentiality & Privacy.

General Approach General Approach

Try to see things from patient point of view. Understand the patients mental status, anxiety, irritation or depression. Always exhibit neutral position.

Always Listen to the Patient.

Questioning: simple/clear/avoid medical terms/open, leading, interrupting, direct questions and summarizing.

1.To take a good history, one has to go down to the level of thinking the pt2. To identify the exact nature of work of the pt. & how the illness affects his day to day work.3.Understanding the language of the pt. is mandatory for correct assessment of history.4. Encourage him to speak freely without any reservation.5. Create an environment for free talk 6. One should be attentive while listening the pt.,do not get diverted.7.Do not show displeasure or dissatisfaction.8. Privacy is important, no outsiders should be allowed.9.Duty of the doctor is to collect a reliable history.10. Always try to greet the pt. by name whenever possible.11.Try to discuss topics unrelated to his ailment.

KEY POINTS

12. If a pt. is giving unnecessary details of a minor point, do not get irritatated, listen patiently & simultaneously ask details of points you feel to be important. 13.Dissuade pts. Or attendants from speaking medical terms without knowing the significance & meaning.14.Dicourage pts. To tell about their t/t & show several consultation & inv. papers.15. Tell them to show them after the end of the conultation, because these papers may misguide the DIAGNOSIS.16. Critical ill pts.- save the life of the pt. first with min. history, stabilise him, then collect data from relatives.Gasping pt.- No history, treatment always precedes diagnosis.

KEY POINTS

THE LEADING QUESTION

Leading question is that which suggests its answer, usually as yes or no.

Leading questions lead to diagnosis.

These questions to be asked to pts. who do not give a cohesive history.

Answers to these questions to cross verified, about their reliabilityOften the pt. replies in yes, to emphasise his complaints& replies in NO if he wants to hide some points.

FROM WHOM HISTORY TO BE COLLECTED

1. Only the patient in ordinary situations.2. Interference by relatives to discouraged .3. Children- Parents, preferably the mother.4. Unconcious Pt- persons who were present at the onset of

illness5. Transient loss of consciousness- TIA,Epilepsy – Eye

witness6. Mental retarded/Deaf & Dumb- Care- takers

OBSERVATION OF NVCNON-VERBAL COMMUNICATIONS

While the pt. is narrating his historyObserve pt. closely - words he uses/emotional attachment to the words - movement of hand & body parts etc, should be noticed.EXAMPLESIf the pt. is weeping,signifies severity of pain- ANGINAL PAINMoving his hands over sternum- RETROSTERNAL IN SITEMoving his hands over a wide area of abd.- ABDOMINAL PAINPoints site of pain with finger- LOCALISED PAIN-PLEURISYGroaning with abd. Pain- COLICKY PAINCloth tied over head or abd. – HEADACHE OR COLICKY AB.PAINTalking in a loud voice- NERVOUS OR DEAFTalking in low voice & looking at this side or other- SEX. PROBLEMWearing warm dress in summer- FEVERUnable to complete a sentence in one breath- low VCGiving extensive details of illness/t/t - HYPOCHONDRIAC

FOR SUCCESSFUL HISTORY TAKING

LIKE ANY OTHER ART ,PRACTICE MAKES A MAN PERFECT

SO ALSO IN THE ART OF HISTORY TAKING ONE HAS TO PRACTICE DAILY TO IMPROVE.

THE MORE ONE FEELS FOR THE PATIENT, THE MORE HE GETS INVOLVED WITH HIM , THE MORE HE EXTRACTS INFORMATIONS FROM HIM (PATIENT)

SENSE OF FEELING & INVOLVEMENT WITH THE PATIENT IS THE SOLE CRITERIA FOR A SUCCESSFUL HT.

KEY ELEMENTS

• Introduce your self (name and position)

• Make a rapport with patient

• Beginning: ‘ Tell me what brought you to hospital’

• Middle stem : Follow structured format

• End: Summarise and ‘Have you got anything else to add or say?’

First Impressions

• Positive Impression– Appearance– Confidence– Demeanor– Body Language

Session Structure

1. Personal Information 5min

2. Chief complaints 10min

3. History of present illness 10min

4. History of Past Illness 10min

5. Systemic enquiry 10min

6. Family history 10min

7. Drug & Treatment history 10 min

8. Social history

9. Others 10min

Pair G

roup

and

Role P

lay

. 1.Personal Information1.Personal Information• Always record personal details:

– Name,– Age,– Address,– Sex,– Ethnicity– Occupation,– Religion,– Marital status. – Date of examination– ASK WHETHER PT IS CASH OR CREDIT – REFD. BY WHOM

Personal Information: Age

• Elderly:-• Dementia

• Osteoarthritis

• Cornary

• Cataract

• Malingnancies

• Chronic lymphatic Leukaemia

• Multiple myeloma

Personal InformationAge:

Children1.Congenital:-

Coarctation

Bicuspid AV

2. Inborn errors of Metabolism

3.Nutritional deficency:

Kwashiorkor, Marasmus, Vit.A Def.

4.Other Common Problems:

FB in ENT

5.Bleeding PR-Rectal polyp

Personal InformationSex:

• Important factor towards the causation of disease:

– In Females:» Endocrine disorders

» Rheumatoid, SLE, Collagen diseases

In Males:Transmitted as x-linked

Haemophilias

Colour blindness

Gout due to def. in HGPRT enzyme.

Duchenne type muscular dystrophy

Smoking & alcohol – Multiple Myeloma

Personal InformationLocality

• Environmental factors:– Dis. Related to Genetic constitution

Chaga’s disease: Brazil, Argentina, Uruguay

Sleeping sickness: Central & West African

Thalassaemia : Mediterranean countries.

Multiple sclerosis &

Sub.ac combined degn Temperate Climate

Of Spinal chord &

Pernicious anaemia :

Carcinoma stomach : Japan

Personal InformationLocality

• Khangri cancer : kashmir

• Goitre : Sub- Himalayan – largest belt in world

• Fluorosis : A.P,TN,Punjab, Harayana,Karnataka

• Kalazar :Bihar & WB

• Dracunculosis : Rajasthan

• Bancroftian filariasis : Orissa, AP,TN,kerala.

Personal Information :Occupation

• Pneumoconiosis

• Silicosis(silicon dusts) sand blasting , ceramic industry .

• Anthracosis (Coal workers)

• Asbestosis (Asbestos workers)

• Byssinosis (Textile workers)

• Brucellosis : Vetenarians

• Anthrax : carrying animal skins on their back.

• Leptospirosis : Sewerage workers

• Lead toxicity : Lead industries

Hypoplastic Anaemia : Exposure to Benzene chemicals.

Hypopalstic anaemia / leukaemia :Prolonged exposure X-Rays Psittacosis and ornithosis. Bird handlers

2.Chief Complaints & History of Present Illness

• The C/C are complaints that brings the pt. for medical help.• U can suggest a few words or phrases to the pt. so that becomes

meaningful.• All c/c should be recorded chronologically.( as all symp. May be

manifestations of 1 illness at diff. stages or related to the other as a cause & effect.

• Usually a single symptom, occasionally more than one complaints eg: chest pain, palpitation, shortness of breath, ankle swelling etc

• The patient describe the problem in their own words.• It should be recorded in pt’s own words.• What brings your here? How can I help you? What seems to be

the problem?

History of Present Illness - Tips

• Elaborate on the chief complaint in detail

• Ask relevant associated symptoms

• Have differential diagnosis in mind

• Lead the conversation & thoughts

• Decide & weigh the importance of minor complaints

History of Present Illness - Tips

• Avoid medical terminology & make use of a descriptive language that is familiar to them

• Ask OPQRSTA for each symptom

Pain (OPQRST)Pain (OPQRST)

Position/site

Severity – how it affects daily work/physical activities. Wakes him up at night, cannot sleep/do any work.

Relationship to anything or other bodily function/position.

Radiation: where moved to

Relieving or aggravating factors – any activities or position

Quality, nature, character – burning sharp, stabbing, crushing; also explain depth of pain – superficial or deep.

Timing – mode of onset (abrupt or gradual), progression (continuous or intermittent – if intermittent ask frequency/ nature.)Treatment received or/and outcome.

Onset of disease

Are there any associated symptoms? .

Chief Complaints

• EXAMPLE 1.

• A patient may come for haemoptysis (say for 2 days), but he fails to tell that he was having cough for two months.

• Alarming symptom: HaemoptysisHere the cough hasn’t been complained by the patient, it has been extracted from him.

His C/C : Cough- 2 m, Haemoptysis – 2 days

Pulmonary tuberculosis: Bronchogenic carcinoma

EXAMPLE 2.• Case 2- Haematemesis – 2days

• On further asking it was revealed that having fever with joint pain – 5 days

• Illness started with fever with joint pain

• To get relief took analgesics – erosive gastritis-

• Haematemesis

• Therefore – haematemesis is not a part of original illness , but is a complication of t/t

True complaints

• Fever -5 days

• Joint Pain – 5 days

• Haemetemesis – 1 day

• Sometimes pt may c/o D yspnoea at rest &

• Palpitation – 5 days

• But on enquiry it was revealed that he is having dyspnoea since 5 yrs

• Dyspnoea – 5yrs/ DAR- 5d/ Palpitation-5d

THE STARTING COMPLAINT• Always emphasis should be given to collect the

correct starting complaint.

• What was the 1st comp.when the pt. felt unwell.

• With the progress of the illness, more & more symptoms get added to the starting complaint.

• Eg: Unconscious pt. with fever & neck rigidity

• - meningitis or S.A haemorrhage

• If 1st cc is Severe headache – S.A.H

• If 1st cc is Fever -Meningitis

THE STARTING COMPLAINT• Ex: 2• A woman with advanced Preg.+Convulsions+LOC• Fever on O/E ( Eclampsia or Encephalitis)

• Episodic convulsions+ High BP – Fever- ECLAMPSIA

• 1st C/C is Fever , then Convulsions – Encephalitis

Duration of illness: Tips• Exact duration of illness• if in months & years –onset is gradual –chronic problem• if in days / hrs- onset is sudden – acute problem• if episodic – epilepsy, bronchial asthma,CCF, AE of COPD

• OTHER PERTINENT POINTS:• For how long you are ill.• When you were completely normal.• Is this complain for the first time or you have other episodes.

Ascertaining the Genuine nature of complaint

• Always try to verify whether c/c is genuine or not.• Convulsions-

• Do not get confused with restlessness + abnormal limb movements

• Associated features-tongue bite,involuntary passage of urine,twisting of the head,rolling of eye ball

• BREATHLESSNESS• If a man doing physical labour complains of

breathlessness its genuine nature can be verified by asking how much effects his work.

• No more able to work, genuine.

Ascertaining the Genuine nature of complaint

• Weight loss

• Often people exaggerate the complaint of weight loss.• This is not always acceptable or believable.• Ask the patient, what was previous weight and when it

was recorded ?• From the present weight you can calculate the weight

loss over that period.• This can also be assessed fairly well from the clothing.• Once significant weight loss is established, very likely

there is a genuine illness.

• Appetite• Frequently patients complain of loss of appetite.• Ask th person who serves food to him.• What is his usual food habit (quantity and quality)

any change or not in this habit can be ascertained from them.

• Vomiting• Fictitious vomiting.• He might be bringing out little amount of saliva

might be retching only.• Ask the pt. to collect all the vomitus and produce

before you.

Ascertaining the Genuine nature of complaint

• Fever and Chill• Record the temperature.• Type of fever - intermittent.. Continuous or chills

Administration of antipyretics.• Maintain a temperature chart at least four to six times

a /week• Then proceed for investigation.

• Remember that if there is recorded fever in any case, there is an organic illness.

Ascertaining the Genuine nature of complaint

• Haemoptysis and Haematemesis• Confusion,cough,nausea,vomiting,melaena,colour of blood

presence or absence of clot or food metarial, froth will help to decide.

• Amount of blood loss.• Absence of melaena.

• Poisoning• Always assess the amount of poison consumed from the

physical signs.• The time gap between the intake and examination• Vomited after intake time.• Intake of the poison and gastric lavage.• Received any treatment period.

Ascertaining the Genuine nature of complaint

• The details of the circumstance under which the illness started will give valuable clue to the diagnosis.

• Diabetes mellitus - hypoglycemic coma• Malaria endemic area few days Delhi epidemic

-dengue fever.

Circumstances under which the Disease Started

• More than one complaint told by the patient gets frankly revealed by tactful questioning.

• These associated complaints help maximum in reaching at the diagnosis.

Associated Complaints

QUESTION & ANS. SESSIONS

Question ?

1.Fever associated with cough and expectoration ?

Answer

1. Respiratory infection.

Question

2. Fever associated with dysuria and frequency ?

Answer

2. Urinary tract infection.

Question

3.Fever associated with jaundice ?

Answer

3.Hepatobiliary disorder, leptospirosis complicated malaria.

Question

4.Fever associated with loss of consciousness?

4.Cerebral malaria,meningitis,encephalitis.

Answer

1. Swelling of the body associated with dyspnoea?

Swelling of the body

Question

Answer

1.Congestive heart failure, angioneurotic oedema.

Question

2. Swelling of the body associated with jaundice?

Answer

1. Subacute hepatic failure, decompensated cirrhosis.

Question

3. Swelling of the body associated with oliguria and haematuria?

1. Acute glomerulonephritis.

Answer

1. Breathlessness associated with chest pain?

Breathlessness

Question

1.Pneumothorax,pulmonary embolism,acute

myocardial infarction.

Answer

Question

2 . Breathlessness associated with wheezing?

Answer

2. Bronchial asthma.

Question

3 . Breathlessness associated with cough and sputum

production?

Answer

3 . Chronic bronchitis.

4 . Breathlessness associated with hemoptysis?

Question

4 . Mitral stenosis, pulmonary infarction.

Answer

1. Joint pain associated with morning stiffness?

Joint pain

Question

Answer

1 . Rheumatoid arthritis.

Question

2 . Joint pain associated with high fever?

2 . Septic arthritis.

Answer

• Significant negative history should be told in relevant cases.

• Unconscious patient complete absence of fever exclude infective condition.

• Absence of syncope angina aortic valve disease, convulsion, absence of head injury and intoxication should be mentioned.

• Ascending paralysis -absence of animal bite.

Negative History

• Effect relationship with present illness.

• Guide the treatment of the present illness.

• History of similar illness.

• History of significant illness.

• Hypertension, diabetes mellitus, tuberculosis and syphilis should be included as these conditions can affect many organs.

History of Past illness

• Ask the patient or his relatives to enumerate all the major illnesses he has suffered from childhood including major accidents and surgeries. From them one has to screen out which is important which is not.

• Produce the documents related to previous illness.

• The patient given history example - rheumatic fever, what age it occurred, joints were affected, how severe was the joint pain, fleeting penicillin prophylaxis.

History of Past illness

• Symptoms like polyuria, polyphagia and polydipsia.

Collecting History of Diabetes Mellitus

• Previous treatment records, X-rays, sputum examination reports.

• Previous history of prolonged fever, persistent cough, hemoptysis, weight loss.

• The drugs prescribed antitubercular drugs.

Collecting History of Tuberculosis

• In a country like india history of hypertension is obtained in a confusing manner.

• Like reeling of head.

• Always emphasis should be given to produce the documentary evidence of hypertension.

• Names of the drugs.

• If a normal recording of blood pressure is found always ascertain whether the patient is no the drugs or off the drugs.

History of Hypertension

• Syphilis in earlier days was the single most important disease to involve almost all organs.

• Primarily it is a sexually transmitted disease.

History of STD

• AIDS - History contact

- Blood Transfusion

- Any injection pride

• Certain diseases are likely to occur in many members of the family.

• Genetically transmitted diseases.

• Familial clustering of diseases.

6.Family History

Family History

• Any familial disease/running in families e.g. breast cancer, IHD, DM, schizophrenia, Developmental delay, asthma, albinism.

• Infections running in families as TB, Leprosy.

• Cholera, typhoid in case of epidemics.

• There are many diseases which are transmitted genetically.

• Genetically transmitted condition can occur in a person without similar illness in the family due to mutation.

• A particular condition may not express completely in all cases (full expression or partial expression).

• History of consanguineous marriage the family

Genetically Transmitted Disease

• Adult polycystic kidney disease

• Multiple neurofibromatosis.

• Hereditary spherocytosis.

• Familial hypercholesterolemia.

• Acute intermittent porphyria and so on.

Autosomal Dominant Disorders

• Albinism

• Wilson’s disease

• Sickle cell anaemia

• Beta thalassaemia

• Cystic fibrosis

Autosomal Recessive Disorders

• Haemophilia

• G6PD deficiency

• Colour blindness

X-Linked Recessive Disorders

9. Personal/ Social History

• Food Habits• Malnutrition allergy or intolerance.• Excess of coffee -Reflux oesophagitis• Excess of tea - Supraventricular ectopics• Vegetarian -vitamin B12 deficiency• Dietary toxins with Khesari dal -(Lathyrism)

Social & Personal History• Smoking history - amount, duration & type. • A strong risk factor for IHD

• Alcohol history - amount, duration & type.

• Occupation, social & education background, ADL, family social support& financial situation.

• Social class.• Home conditions as:

• Water supply.• Sanitation status in his home & surrounding.

• Animals / birds in his/her house.

Social History: smoking• The most important cause of preventable diseases.• Smoking history - amount, duration & type. • Amount: pack”year calculations.• Duration: continuous or interrupted.• Any trials of quitting & how many.• Deep inhalation or superficial.• Active or passive smoker.• Type: packs, self-made, Cigars, Shesha , chewing etc.

Addiction and Habituation

• Alcohol• GI system – gastritis, pancreatitis, fatty liver, hepatitis,

cirrhosis of liver, the nervous system, peripheral neuropathy, Korsakoff’s psychosis, cerebellar degeneration, dementia.

• Smoking – Chr.Bronchitis, Broncho.Ca.,CAD,

• Gudakhu

• Oral tobaco – oral cancer

• Opium – Constipation- Do not respond to analgesics and sedatives.

• Drugs - Narcotics and benzodiazepines abuse• Sleep

– Insomnia – unfavourable environment

- Physical illness, orthopnoea, or any painful condition

• Excessive sleep – Alcohol, sedatives, hypothalamic, disorders, Pickwickian syndrome.

• Reversal sleep Rhythm (night time insomnia & day time somnolence – old age

Addiction and Habituation

Bowel and Bladder

Recent change in Bowel habits – Colorectal.ca

Recent onset of diarrhoea – infective

BLADDER HABITS

- Women evacuate bladder less frequently than males.-Disturbances in bladder habit takes several forms like -Increased frequency of urination, polyuria, oliguria, hesitancy, urgency, dysuria, incontinence, retention, etc.

Socioeconomic Status

• Poor SES status – Various infection, infestations, nutritional def.

• High SES status – sedentary lifestyle, obesity & related problems.

7.Drug & Treatment History

• Drug History (DH)• Always use generic name or put trade name in brackets with

dosage, timing &how long. • Example: Ranitidine 150 mg BD PO• Note: do not forget to mention:

OCT/Vitamins/Traditional /Herbal medicine & alternative medicine

• Blood transfusion.• ALLERGY OR SENSITIVE DO DRUGS.• ANY T/T OR SURGERY

Menstrual & obstetrics HistoryMenstrual & obstetrics History

• Gyn/Obstetric history if female

• Gravida, para, abortions, C- sections, antenatal care & screening for Hep B & C.

• Menarchy & Menopause

• Menstrual cycles

• LMP

Other Relevant HistoryOther Relevant History

• Immunization if small child• Note: Look for the child health card.• Travel / sexual history if suspected STDs or infectious

disease• Note:• If small child, obtain the history from the care giver.

Make sure; talk to right care giver.• If some one does not talk to your language, get an

interpreter(neutral not family friend or member also familiar with both language).

• Ask simple & straight question but do not go for yes or no answer.

System Review (SR)System Review (SR)

This is a guide not to miss anything

Any significant finding should be moved to HPC or PMH depending upon where you think it belongs.

Do not forget to ask associated symptoms of Present Complaints with the System involved

When writing up patient notes, record the systems review so that the relieving doctors know what system you covered.

System ReviewSystem Review

General •Weakness•Fatigue•Anorexia•Change of weight•Fever/chills•Lumps•Night sweats

System ReviewSystem Review

Cardiovascular•Chest pain•Paroxysmal Nocturnal Dyspnoea•Orthopnoea•Short Of Breath(SOB)•Cough/sputum (pinkish/frank blood)•Swelling of ankle•Palpitations•Cyanosis

System ReviewSystem Review

Gastrointestinal/Alimentary •Appetite (anorexia/weight change)•Diet•Nausea/vomiting•Regurgitation/heart burn/flatulence•Difficulty in swallowing•Abdominal pain/distension•Change of bowel habit•Haematemesis, melaena, haematochezia•Jaundice

System ReviewSystem Review

Respiratory System•Cough(productive/dry)•Sputum (colour, amount, smell)•Haemoptysis•Chest pain •SOB/Dyspnoea•Tachypnoea•Hoarseness•Wheezing

System Review System Review

Urinary System•Frequency•Dysuria•Urgency/strangury•Hesitancy •Terminal dribbling•Nocturia•Back/loin to groin pain•Incontinence•Character of urine: colour/ amount (polyuria) & timing•Fever

System Review System Review

Nervous System•Visual/Smell/Taste/Hearing/Speech problem•Headache•Fits/Faints/Black outs/loss of consciousness•Muscle weakness/numbness/paralysis•Abnormal sensation•Tremor•Change of behaviour or psyche.•Paresis.

System Review System Review

Genital system •Pain/ discomfort/ itching•Discharge•Unusual bleeding•Sexual history•Menstrual history – menarche/ LMP/ duration & amount of cycle/ Contraception/ menopause/PMB•Obstetric history – Para/ gravida/abortion

System Review System Review

Musculoskeletal System•Pain – muscle, bone, joints•Swelling•Weakness/movement•Deformities•Gait

SOAPSOAPSubjective: how patient feels/thinks about him. How does he look. Includes PC and general appearance/condition of patient

Objective – relevant points of patient complaints/vital signs, physical examination/daily weight,fluid balance,diet/lab. investigation and interpretation

Plan – about management, treatment, further investigation, follow up and rehabilitation

Assessment – address each active problem after making a problem list. Make differential diagnosis.

SUMMARY

1.PERSONAL INFORMATION2. CHIEF COMPLAINTS3.HISTORY OF PRESENT ILLNESS4.HISTORY OF PAST ILLNESS5.FAMILY HISTORY6.PERSONAL /SOCIAL HISTORY7. DRUG & TREATMENT HISTORY8.MENSTRUAL & OBTETRICS HISTORY9.SYSTEMIC REVIEW10.TO REACH APROVISIONAL DIAGNOSIS

ERROR IN HISTORY TAKING

Wrong or incomplete history

Improper sequence of history taking

Identification of malingering

Ignoring the family & Relatives

Not maintaining privacy

Biggest medical mistakes

The Andrews

Family

When in an in vitro fertilization centre ..

The wrong sperm was inseminated!!!

Jesica Santillan, 17

Died two weeks after

Receiving incompatible heart and lungs during a transplantation

Benjamin Houghton47-year-old Air Force veteran

Got his healthy right testicle mistakenly removed in a case of a wrongful operation

Failure on the part of medical personnel to mark the proper surgical site before the procedure, spurred a $200,000 lawsuit from Houghton and his wife.

Donald Church, 49

Arrived at the University of Washington Medical Center to get his tumor removed

On leaving, his tumor was gone, but

But a 13’’ metal retractor had taken its

place!!

Joan Morris, 67 admitted to a

teaching hospital for

cerebral angiography

mistakenly underwent an invasive cardiac

electrophysiology study!

she was taken for a open heart procedure and

operated for an hour!!

Doctors had made

an incision in her groin, punctured an artery, threaded in a tube

and snaked it up into

her heart!!!

Only when her consulting doctor informed the team on phone, did they sent her back to her ward in stable condition

operated on the wrong side of an 82 year old patient's

head

Not Once

Not Twice

Willie King got

his wrong

leg removed

in an amputati

on operatio

n

The surgeon's

team realized in the middle

of the procedure that they

were operating

on the wrong leg

Park Nicollet Methodist Hospital

Removed the healthy kidney of a patient who came for a kidney tumor operation

Raleigh General Hospital

in Beckley

Performed an abdominal surgery on a

73 year old patient

Without administering general anesthesia!!

The patient could feel every slice of the doctor’s

scalpel and..

Committed suicide in a state of trauma

Dana Carvey, the well known

American comedian and actor

Got his wrong artery bypassed

And thus filed a $7.5 million lawsuit against the doctor

SO WHAT HAVE WE DECIDED ?

OUR RESOLUTION 2013

GOOD HISTORY TAKING IS ABSOLUTELY NECESSARY TO MAKE AN EXCELLENT PHYSICIAN

SO TODAY OUR DECISION IS:

WE SHOULD ALWAYS BE A CARING DOCTOR

THANK YOU ALL