Preoccupied mind misdiagnoses

Acute Appendicitis

Acute Appendicitis (Photo credit: euthman)

This is about an incident that took place last week. I was in ER when I had to take handover of case of 12 years boy who had come with the complaint of acute onset of diarrhoea and vomiting with abdominal pain. Since this time we had been receiving mostly the cases of AGE we thought this was another of the same variety. So the preliminary investigation management was done in the line of AGE and when the pain subsided and he become more alert he was discharged after counselling about further management at home.

Some hours afterwards, he came back saying the pain is not going away. So we thought it would be better to admit and evaluate him by having specialist’s opinion. the boy was then thoroughly investigated and later was found to be a case of Appendicitis.

What i am trying to say is not how we misdiagnose the case or how we can be reckless but about the tendency that develops with the experience. This is in fact one of the danger of the experience based practice. Had we relied on the standard protocol of clinical evaluation, we may not have missed the diagnosis of appendicitis but since we were more comfortable relying on our experience and that we thought was actually minimising the hassles of going through everything we overlooked one very important differential.

As a medical student and recent graduate this is not a very uncommon scenario for many. So the point here is to keep mind free but at the same time alert. so that we would not be making preoccupied diagnoses.

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