CHF mislabeled as COPD

Vic Nicholls nichollsvi2 at GMAIL.COM
Sat Jan 25 17:40:09 UTC 2014


Is it possible to "mark" somewhere that someone has X diagnosis but not
ruled out diagnoses Y and Z? Or possibility of diagnoses Y and Z in the
chart? That way, everyone keeps the stethoscope but the patient still
can be checked for the other items, just in case.

That would seem to be a win win situation for all? Or is there something
I missed out - first thing I can think of is that EHR's don't have a
"checkbox" or space to put other diagnoses.

Victoria

On 1/25/2014 12:52 AM, Robert Bell wrote:
> Another problem is embolism being labelled heart trouble, and
> bronchiectasis, TB and MAC infections called asthma. Similar
> diagnostic problems. Further history and lab work, including Factor V
> Leidin, etc. And X-ray or CT might help to differentiate.
>
> However, we do not know if the stethoscope in different hands is more
> dangerous than helpful - and this after 150 years of stethoscope use.
> I have wondered if the studies are resisted because the stethoscope is
> associated with physicians/HCPs and is essentially their status
> symbol. How would HCPs react/feel if evidence based medicine
> recommended the stethoscope only be used for blood pressure
> measurements in those with say less that 10 years of experience? Or
> something like that. Are we keeping an inaccurate instrument around
> because of its role as a status symbol? I am not sure.
>
> Rob Bell, MD., Ph.C.
>
> Sent from my iPad
>
> On Jan 22, 2014, at 8:57 AM, Karen Cosby <kcosby40 at GMAIL.COM
> <mailto:kcosby40 at GMAIL.COM>> wrote:
>
>> Yes we recognize this is a common problem, although more with
>> patients labeled as asthma.  In part it's because both conditions may
>> occur in the same patient.  Patients in the ED often have
>> longstanding and poorly controlled asthma/COPD, and many have right
>> heart failure with edema. Detecting new CHF in those patients can be
>> difficult.  It even more problematic because asthmatics in many EDs
>> are triaged to an area where they are treated in chairs and aren't
>> undressed for a full exam.  We recognized this as a problem and
>> developed standard questionnaires for examiners to complete
>> specifically targeting questions to elicit signs and symptoms that
>> might require a more thorough exam/evaluation for alternative
>> conditions.  We tell our residents that one of the main priorities we
>> expect in the evaluation of asthma is to detect conditions other than
>> asthma.  We haven't tried to quantitate this problem, but have it
>> among our list of common causes of mis-diagnoses.
>>
>>
>> On Mon, Jan 20, 2014 at 9:22 PM, Abdul Saadi <essadii at gmail.com
>> <mailto:essadii at gmail.com>> wrote:
>>
>>     Anyone aware of good literature on the mislabeling of CHF as
>>     COPD? Is there any estimates. Is this a problem that anyone sees
>>     with any frequency or is it just me? Is it slipping stethoscope
>>     skills or failure to take into account the whole patient
>>     presenation?
>>
>>     Abdul Saadi,MD
>>     Temple University
>>
>>
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