A 40-year-old man had a diagnosis of disseminated melanoma. The diagnosis was made after a surgical biopsy from an inguinal adenopathy. When he was going to be discharged he suffered a syncope. A blood test showed an hemoglobin level of 7,5 g/dl, coincident with abdominal pain.
A 55-year-old male patient had a diagnosis of colon cancer with painful spine metastases. He had a previous diagnosis of atrial fibrillation. He had to stay at the hospital to receive radiotherapy to control back dorsal pain
Catherine R. Lucey is a very well known expert in clinical reasoning and problem solving. This is a summary from her Conference centered in the conditions to implement a meeting to analyze Diagnostic Error.
He considere The spectrum of Disrespectful Behavior:
A. Overt: disruptive/demeaning Behavior of physicians
B. Covert: Passive resistance: “the major cause of failure of QI and safety projects is a lack of physician participation”.
C. Institutional Disrespect: of workers ( workplace environment,workloads, psychological disrespect) and of patients(sharing decisions,)
When I was reading some papers about cancer in adolescents and young adults (AYA) I was shocked when I discovered the high relative incidence of thyroid cancer in young girls. After the Chernobyl disaster we know that radiation exposure is a risk factor but little is known about other associations.Incidence rate: 1/200.000
I got a clear take home message: Don,t forget to include the thyroid in the physical examination of an adolescent or young adult girl.
Bone or muscular pain is common in adolescents (15-19-year-old). Growth and sport activity, are usually explanations for many of these situations. But like a needle in a haystack , there are two types of tumors that can be easily missdiagnosed: Ewing´ s sarcoma and osteosarcoma…
The decision making process when a patient has a mass in the anterior neck must be quick and precise because a vocal cord paralysis, a tracheal estenosis or a pulmonary aspiration can be present…. Continue reading