Commonest error in medicine?

darryl mackender dmack2795 at GMAIL.COM
Tue Nov 25 04:34:04 UTC 2014


Robert & Bill & others
PTE is certainly commonly misdiagnosed, & undoubtedly often over diagnosed
but is also a common dual diagnosis (The Ockhams Razor error) but I suspect
in non-Cancer ambulatory general medical inpatient admissions the incorrect
diagnosis of sepsis as CAP or urosepsis without much corroborating evidence
is more common as both over & under diagnosis & probably of greater quantum
of consequence - sepsis or suspected system specific infection ( CAP,
gastroenteritis, urosepsis, septic arthritis, cellulitis, meningitis) needs
to be seen as a syndrome can diagnosis with major & minor criteria & a
diagnosis as probable, or suspected or confirmed ala Rheum Dx.
There is ample data on these broad areas to consolidate a core set of major
& minor criteria for suspected sepsis that applies to each organ set.
We could then develop a pathway approach much as suspected Acute Coronary
syndromes have been managed to deal with undifferentiated chest pain. We
may not have a troppo in equivalent for many organ sets but a proxy which
is as close to a troponin-like criteria can be developed for each organ set.

It needs to be generalisable & emphasise evidence based history taking &
evidence based physical signs before complex investigations unless they are
as easy to use as troponin & quantifiable D-dimer.

Darryl Mackender
Director Physician Training Orange NSW


On Tuesday, November 25, 2014, Slater, William <WSlater at phcn.vic.gov.au>
wrote:

>  Ok, Robert. I like this.
>
>
>
> Are you suggesting that PE is no 1 miss-diagnosis or perhaps
> over-diagnosis?
>
> Or are CTPAs (with the radiation exposure) done far too often because the
> d-dimer test is misused or misinterpreted??
>
>
>
> In my view we may be over-diagnosing and therefore over-treating small,
> clinically insignificant PEs.
>
>
>
>
>
> Bill Slater FRACP
>
>
>
> Director Physician Education Peninsula Health Melbourne
>
>
>
> *From:* robert bell [mailto:rmsbell at ESEDONA.NET
> <javascript:_e(%7B%7D,'cvml','rmsbell at ESEDONA.NET');>]
> *Sent:* Tuesday, 25 November 2014 11:41 AM
> *To:* IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
> <javascript:_e(%7B%7D,'cvml','IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG');>
> *Subject:* [IMPROVEDX] Commonest error in medicine?
>
>
>
> A thought.
>
>
>
> Do we know what is the most common serious error in diagnosis in medicine
> in the USA?
>
>
>
> If not can we guess at what is the commonest error in diagnosis? And then
> perhaps the top five.
>
>
>
> Then could we discuss intensely on line and come to conclusions as to how
> we could lower that rate?
>
>
>
> When we have come up with a list of suggestions for that one error we move
> on to Number 2  on what we think is the list of commonest serious errors in
> Medicine and how to reduce their incidence.
>
>
>
> This way we would be doing something positive rather than just talking.
> Not that talking is important.
>
>
>
> My contribution for serious No. 1 is Pulmonary embolism.
>
>
>
> This way we could just on line make a seripous contribution to medicine
> particularly if someone would write up our discussions.
>
>
>
> A thought
>
>
>
>
>
> Robert M. Bell, M.D., Ph.C.
>
>
>
>
>
>
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