Miss diagnosis
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Transcript of Miss diagnosis
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Why did I miss the diagnosis?
Dr Bhupendra Shah
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Type of miss diagnosis
Misdiagnosis
Missed diagnosis
Delay in diagnosis
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Why should we are discussing ? Prevalent
consequential
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Similarities and contrast……
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73 year /female abdominal distension-10 days dry cough- 10 days USG-Ascites with mesenteric lymphadenopathyXray- Left pleural effusionDiagnosis: disseminated Tuberculosis
abdominal distension persistent and appetite decreasingpresented with altered sensoriumserum Na -110 mg/dlhyponatremia treated and sensorium improvedDx—hyponatremia due to poor intake
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What happen next?
Patient deteriote
Pleural effusion –progressive increasing
Pleural fluid cytology…metastasis (adenocarcinoma)
My patient suffer..who is resposnsible?
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Why ???
History incomplete……
Physical examination not complete
Not analysed
Excessive reliance on lab report
Hyponatremia cause ….not analysed
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65 year /male Loose motion -2 years Visited MOPD 4 times Given antibiotic No releived Colonoscopy planned …patient lost
follow up for 8-9 months with no releived of symptoms
Visited another doctor Diagnosis made..treated
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26 year /male Fever -5 days , vomitting- 2 days Urine analysis-pyuria Dx-UTI discharge on antibiotics No releive of symptoms and visited other
hospital Dx –UTI with GERD Altered sensorium-1 days CT scan- frontotemporal enhancement
with diffuse brain edema
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$1,600,000 settlement in a medical malpractice case involving the failure to take an adequate biopsy of a patients ulcer and thereby failure to diagnose gastric cancer.
$90,939,857 jury verdict for a child whose cerebral palsy was due to the failure of an obstetrician to diagnose placental abruption and who thus delayed the cesarean section that was necessary to rescue the baby who was suffering from a lack of oxygen.
$8,000,000 settlement for a woman in case in which doctors and hospital employees failed to timely diagnose a valvulus (twisting of the intestine) in a woman which cased multiple surgeries and hospitalizations and the need for an intestinal transplant.
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MONDAY, April 22 (HealthDay News) :
Missed or wrong diagnoses made up the lion's share of U.S. malpractice payouts -- which totaled nearly $39 billion -- during the past 25 years, finds a new study of more than 350,000 claims.
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अस्पतालमा तोडफोड ।
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What went wrong??? And why?
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Why did you miss the diagnosis It never crossed my mind.
Too much attention to one finding
Too much in hurry
Didn’t re-asses the situation
Influenced by similar case
Let the consultant convince me
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Errors
Faulty detection
Faulty triggering of hypothesis
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Most powerful diagnostic tool History
Examination skill
Reasoning abilities
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Data gathering errors Incomplete history
Ineffective questioning
Faulty detection
Failure to screen
Overreliance on someone else’s history
Faulty physical examination technique
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Data integration
Failure to consider finding
Faulty estimate of prevalence
Faulty context formulation
Overreliance on someone else’s opinion
Over or underestimation of finding
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Situational errors Stress
Fatigue
Excessive workload
Physician mood and personality
Work environment :equipment ,support ,rewards and punishment.
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Error in physical examination Technique
Omission
Detection
Intrepetation
recording
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What to do now?????/
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Analytical thinking
If you don’t know what to see ,you won’t see no matter how throughly you look for it.
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Is it possible?
Self recognition
Assuming responsibility
Sharing emotions
Encourging people to share their thinking
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Hello…………
Everyone makes mistake..no matter how confident anyone are in their abilities ,they are human.
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Unfortunately …….
This is doesn’t apply to doctor…..
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What next?
To ask
Why I miss the diagnosis?
Why you miss the diagnosis?
Why we miss the diagnosis?
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references
Bordage G. Why did I miss the diagnosis? Some cognitive explanations and educational implications. Acad Med 1999;74:S138-S143.
Judith L. Bowen.Educational Strategies to Promote Clinical diagnostic Reasoning .N Engl J Med 2006;355:2217-25.
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Thank you
Sir for motivating me to present this topic.
All for your participation