Diagnostic Error: a cultural problem Dr.Lucian Leape)

Dr. Leape has enhanced the importance of “respect” in general to improve health care.

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,)

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Thyroid cancer in young girls: I didn,t expect it



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.

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Bone tumors in adolescents: not an easy diagnosis





Ewing´s sarcoma (perone)

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…

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A big lump in the anterior cervical area: a differential diagnosis




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

Brain metastases: a learning curve


Brain metastases has a clear pattern inside a doctor ´s mind: headache (40-50%), focal neurologic dysfunction (20-40%) with hemiparesis as the most common symptom, cognitive dysfunction, seizures (10-20%) and stroke (5-10%) (uptodate).But there is a “learning” curve composed of small details in my own experience related with the affected area. Continue reading

Prostate drug ruling ‘a fiasco’


Prostate drug ruling ‘a fiasco’ http://www.bbc.co.uk/news/health-28785250

Medicine nowdays is based in a therapeutic revolution. Cancer Medicine is an example,but cost is an important issue in time of economical crisis. What is the value of two months of life for one patient? This is not only an economical issue, ethics must play also a key role