Misdiagnosis - a fear
A cardiac arrest call was sent out during my on call today. It was an elderly lady sent in by the paramedics after collapsing on the floor. CPR was done by them for 30 minutes before a pulse was detected on her, and the total journey to the hospital was about 1 hr.
The ECG showed a massive MI (aka heart attack). Her blood pressure was extremely low, and her oxygen saturations were low as well. The cardiac monitor showed an abnormal rhythm, and we managed to got it back on track by pacing it.
Apparently, this lady has been complaining of chest pain for 3 days, and has been seen by the GP, who didn't send her into the hospital. And this chest pain was actually a MI.
She died in the end.
I was talking to my Consultant about lesions seen on chest xrays. Mum had an xray done about 2 mths back, and there was a lesion, which her Cardiologist thinks it's a granuloma. Mum was worried that the lesion could be lung cancer, and asked for my opinion. It does look like a granuloma, looking different from the typical spiculated lung cancer lesion I normally would see on chest xrays. But today, my Consultant told me that it is difficult to differentiate from the 2 with a plain chest xray film. Obviously, the history will be able to give us clues as to whether it's more likely to be a granuloma or a cancer, but then again, many lung cancer patients present late and can go asymptomatic until very late stages. This got me very worried, and I can't help pondering abt it on my way back after work. Sent Dad a sms to get him to let Aunt Linda look at the xray for a 2nd opinion. I definitely don't want to misdiagnose and regret my whole life if my assumption is wrong.
The cardiac arrest reminded me of the consequences of a misdiagnosis.
This is the fearful part of being a doctor. Doctors aren't god, and many times things aren't within our control. But we can save someone, yet kill someone if the diagnosis is wrong. The cardiac arrest resulted from a misdiagnosis, and having killed a person was the consequence of this. I was asking myself this when it happened..."What if I was the doctor who misdiagnosed this?"
When I saw this patient lying in the Resuscitation, I thought abt my uncle. It's been 6-7 yrs now, and I have not forgotten. Neither do I think I ever will. I haven't paid my respects to him in the temple for a long time, and each time I see his tablet with his smiling photo, this strong feeling of guilt will stir in me. Until today, I cannot forgive myself for what happened and neither can I forget how my cousin was crying really badly next to his corpse and talking to him.
I still blame myself till now for being only a pathetic 1st or 2nd year medical student, who hasn't been taught anything clinical, hence, I had absolutely no clinical knowledge. He was telling me that he's having some chest discomfort and difficulty breathing, and thought it was probably due to alcohol. I thought it was due to alcohol as well, and even told him that he'll be fine. And the next day, he died. If only I could go back to the same situation with my current knowledge, I would have sent him to the hospital immediately. Probably things would be completely different now.
Although I have managed to diagnose many cases correctly now, I know my fear is still present.
With the case for Mum, I don't feel comfortable at all now. Maybe I'm being paranoid, but I really don't want to make another mistake which will haunt me for life, especially when she's my Mum.
The ECG showed a massive MI (aka heart attack). Her blood pressure was extremely low, and her oxygen saturations were low as well. The cardiac monitor showed an abnormal rhythm, and we managed to got it back on track by pacing it.
Apparently, this lady has been complaining of chest pain for 3 days, and has been seen by the GP, who didn't send her into the hospital. And this chest pain was actually a MI.
She died in the end.
I was talking to my Consultant about lesions seen on chest xrays. Mum had an xray done about 2 mths back, and there was a lesion, which her Cardiologist thinks it's a granuloma. Mum was worried that the lesion could be lung cancer, and asked for my opinion. It does look like a granuloma, looking different from the typical spiculated lung cancer lesion I normally would see on chest xrays. But today, my Consultant told me that it is difficult to differentiate from the 2 with a plain chest xray film. Obviously, the history will be able to give us clues as to whether it's more likely to be a granuloma or a cancer, but then again, many lung cancer patients present late and can go asymptomatic until very late stages. This got me very worried, and I can't help pondering abt it on my way back after work. Sent Dad a sms to get him to let Aunt Linda look at the xray for a 2nd opinion. I definitely don't want to misdiagnose and regret my whole life if my assumption is wrong.
The cardiac arrest reminded me of the consequences of a misdiagnosis.
This is the fearful part of being a doctor. Doctors aren't god, and many times things aren't within our control. But we can save someone, yet kill someone if the diagnosis is wrong. The cardiac arrest resulted from a misdiagnosis, and having killed a person was the consequence of this. I was asking myself this when it happened..."What if I was the doctor who misdiagnosed this?"
When I saw this patient lying in the Resuscitation, I thought abt my uncle. It's been 6-7 yrs now, and I have not forgotten. Neither do I think I ever will. I haven't paid my respects to him in the temple for a long time, and each time I see his tablet with his smiling photo, this strong feeling of guilt will stir in me. Until today, I cannot forgive myself for what happened and neither can I forget how my cousin was crying really badly next to his corpse and talking to him.
I still blame myself till now for being only a pathetic 1st or 2nd year medical student, who hasn't been taught anything clinical, hence, I had absolutely no clinical knowledge. He was telling me that he's having some chest discomfort and difficulty breathing, and thought it was probably due to alcohol. I thought it was due to alcohol as well, and even told him that he'll be fine. And the next day, he died. If only I could go back to the same situation with my current knowledge, I would have sent him to the hospital immediately. Probably things would be completely different now.
Although I have managed to diagnose many cases correctly now, I know my fear is still present.
With the case for Mum, I don't feel comfortable at all now. Maybe I'm being paranoid, but I really don't want to make another mistake which will haunt me for life, especially when she's my Mum.
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