8. Patient deteriote
Pleural effusion –progressive increasing
Pleural fluid cytology…metastasis
(adenocarcinoma)
My patient suffer..who is resposnsible?
9. History incomplete……
Physical examination not complete
Not analysed
Excessive reliance on lab report
Hyponatremia cause ….not analysed
10. 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
11. 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
12. $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.
13. 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.
16. 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
19. Incomplete history
Ineffective questioning
Faulty detection
Failure to screen
Overreliance on someone else’s history
Faulty physical examination technique
20. Failure to consider finding
Faulty estimate of prevalence
Faulty context formulation
Overreliance on someone else’s opinion
Over or underestimation of finding
21. Stress
Fatigue
Excessive workload
Physician mood and personality
Work environment :equipment ,support
,rewards and punishment.
30. To ask
Why I miss the diagnosis?
Why you miss the diagnosis?
Why we miss the diagnosis?
31. 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
EnglJ Med 2006;355:2217-25.
32. Sir for motivating me to present this topic.
All for your participation