miss diagnosis is common in medical practice.It is common,preventable and punishable act done by by medical practioner.

4.  Misdiagnosis
 Missed diagnosis
 Delay in diagnosis

5.  Prevalent
 consequential

8.  Patient deteriote
 Pleural effusion –progressive increasing
 Pleural fluid cytology…metastasis
(adenocarcinoma)
 My patient suffer..who is resposnsible?

9.  History incomplete……
 Physical examination not complete
 Not analysed
 Excessive reliance on lab report
 Hyponatremia cause ….not analysed

10.  65 year /male
 Loose motion -2 years
 Visited MOPD 4 times
 Given antibiotic
 No releived
 Colonoscopy planned …patient lost follow up
for 8-9 months with no releived of symptoms
 Visited another doctor
 Diagnosis made..treated

11.  26 year /male
 Fever -5 days , vomitting- 2 days
 Urine analysis-pyuria
 Dx-UTI discharge on antibiotics
 No releive of symptoms and visited other
hospital
 Dx –UTI with GERD
 Altered sensorium-1 days
 CT scan- frontotemporal enhancement with
diffuse brain edema

12.  $1,600,000 settlement in a medical malpractice case involving the
failure to take an adequate biopsy of a patients ulcer and thereby
failure to diagnose gastric cancer.
 $90,939,857 jury verdict for a child whose cerebral palsy was due to
the failure of an obstetrician to diagnose placental abruption and
who thus delayed the cesarean section that was necessary to rescue
the baby who was suffering from a lack of oxygen.
 $8,000,000 settlement for a woman in case in which doctors and
hospital employees failed to timely diagnose a valvulus (twisting of
the intestine) in a woman which cased multiple surgeries and
hospitalizations and the need for an intestinal transplant.

13.  MONDAY, April 22 (HealthDay News) :
Missed or wrong diagnoses made up the lion's
share of U.S. malpractice payouts -- which
totaled nearly $39 billion -- during the past 25
years, finds a new study of more than 350,000
claims.

14. अस्पतालमा तोडफोड ।

16.  It never crossed my mind.
 Too much attention to one finding
 Too much in hurry
 Didn’t re-asses the situation
 Influenced by similar case
 Let the consultant convince me

17.  Faulty detection
 Faulty triggering of hypothesis

18.  History
 Examination skill
 Reasoning abilities

19.  Incomplete history
 Ineffective questioning
 Faulty detection
 Failure to screen
 Overreliance on someone else’s history
 Faulty physical examination technique

20.  Failure to consider finding
 Faulty estimate of prevalence
 Faulty context formulation
 Overreliance on someone else’s opinion
 Over or underestimation of finding

21.  Stress
 Fatigue
 Excessive workload
 Physician mood and personality
 Work environment :equipment ,support
,rewards and punishment.

22.  Technique
 Omission
 Detection
 Intrepetation
 recording

23.  What to do now?????/

26.  If you don’t know what to see ,you won’t see
no matter how throughly you look for it.

27.  Self recognition
 Assuming responsibility
 Sharing emotions
 Encourging people to share their thinking

28.  Everyone makes mistake..no matter how
confident anyone are in their abilities ,they
are human.

29.  This is doesn’t apply to doctor…..

30.  To ask
 Why I miss the diagnosis?
 Why you miss the diagnosis?
 Why we miss the diagnosis?

31.  Bordage G.Why did I miss the diagnosis?
Some cognitive explanations and educational
implications. Acad Med 1999;74:S138-S143.
 Judith L. Bowen.Educational Strategies to
Promote Clinical diagnostic Reasoning .N
EnglJ Med 2006;355:2217-25.

32.  Sir for motivating me to present this topic.
 All for your participation