listening the patient

Michael Grossman Michael.Grossman at MIHS.ORG
Tue Oct 25 17:00:33 UTC 2016


 Edita, Thank you for the more complete story line.

This history is unfortunately more understandable AND you are correct, not a fully developed history. There seems to be a propensity for "short cut" gathering of information ( including the lack of physical examination)

that allows this type of error to take place.

I view this as a form of premature closure , but believe it is stimulated by time pressure and lack of appreciation of the value of complete information.

Unfortunately I think it is a pretty wide spread phenomenon.

mg



Michael Grossman, MD, MACP

Special Assistant to the Dean

Professor, Internal Medicine

Professor, Biomedical Informatics

College of Medicine Phoenix

________________________________
From: Edita Falco [edita.falco at gmail.com]
Sent: Tuesday, October 25, 2016 9:46 AM
To: Michael Grossman; Society to Improve Diagnosis in Medicine
Subject: Re: [IMPROVEDX] listening the patient

Dear doctor Grossman
the story is as follows
1.Girl eats chicken
2-Girl feels adifficultyl when swallowing
3-A couple of days later feels chest pain, fever
4-Goes to the doctor
5-Gets an RX and is told to have flu
6-A week after the chicken food she wakes up with a violent hematemesis
7-Comes to the hospital
8-The mother founds chicken bone in the vomit.blood
9-Diagnosis is suspected(perforation of oesophagus and aortic vessel
10-vascular surgeon sutures both
11-Girl dies after some days in the ICU due to suture failure

the  fact i wanted to point is that the doctor who attended the first  complain did not pay attention to the whole history and did not suspect  the origin of the symptoms
So sorry for the confuson
edita

On Tue, Oct 25, 2016 at 1:42 PM, Edita Falco <edita.falco at gmail.com<mailto:edita.falco at gmail.com>> wrote:
Dear doctor Grossman
the story is as follows
1.Girl eats chicken
2-Girl feels adifficultyl when swallowing
3-A couple of days later feels chest pain, fever
4-Goes to the doctor
5-Gets an RX and is told to have flu
6-A week after the chicken food she wakes up with a violent hematemesis
7-Comes to the hospital
8-The mother founds chicken bone in the vomit.blood
9-Diagnosis is suspected(perforation of oesophagus and aortic vessel
10-vascular surgeon sutures both
11-Girl dies after some days in the ICU due to suture failure

the  fact i wanted to point is that the doctor who attended the first  complain did not pay attention to the whole history and did not suspect  the origin of the symptoms
So sorry for the confuson
edita

On Tue, Oct 25, 2016 at 1:27 PM, Michael Grossman <Michael.Grossman at mihs.org<mailto:Michael.Grossman at mihs.org>> wrote:

The story you relate seems almost impossible. Who saw the patient? its not non listening , but rather active DISREGARD, not just for the historic information , but equating massive hematemesis with a "flu"  diagnosis seems a bit out of touch.



Michael Grossman, MD, MACP

Special Assistant to the Dean

Professor, Internal Medicine

Professor, Biomedical Informatics

University of Arizona College of Medicine Phoenix

________________________________
From: Edita Falco [edita.falco at GMAIL.COM<mailto:edita.falco at GMAIL.COM>]
Sent: Tuesday, October 25, 2016 7:08 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] listening the patient

Dear colleagues

Absolutely true!!!  the patients tell the story.... if we know how to listen

Short story
teen ager comes to ward with huge hematemesis.Her mother shows a chiken bone the girl has vomited with the blood-
some days before   she had suffered a problem while eating ..later feels chest
disconfort, malaise, fever..Goes to doctor gets a RX and is sent home with
flu diagnosis...nobody paid atention to the incident.
The bone had eroded
the esophagus and produced an aortic tear...she died days after being
repared the lesion
nobody listened the true story
edita

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