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Sunday, January 28, 2007

Why Did I Miss It?: A misdiagnosis

The Emergency Room doctor's story:

Evan McKinley (not his real name) was hiking when he felt a sharp pain in his chest. He was a forest ranger in his early forties, trim and extremely fit. He had felt discomfort in his chest for several days, but this was more severe: it hurt each time he took a breath. He decided to see a doctor in a nearby hospital’s emergency room.

The emergency room doctor noted that McKinley had never smoked or been overweight; had no family history of heart attack, stroke, or diabetes; and was under no particular stress. His family life was fine, he said, and he loved his job. His blood pressure, pulse, lungs and heart appeared normal when the doctor examined him, and an electrocardiagram (EKG), chest X-ray, and blood tests also seemed normal. The emergency room doctor concluded that McKinley must have a muscle strain, and told him not to worry about the chest pain.

The next morning, McKinley had a heart attack (an acute myocardial infarction) that could have cost him his life. The doctor later explained, “Why did I miss it? I didn’t miss it because of any egregious behavior, or negligence. I missed it because my thinking was overly influenced by how healthy this man looked, and the absence of risk factors.”

Emergency room doctors have a particularly difficult diagnostic challenge because they often have very little information on a patient’s history.

Advice to patients: Keep your personal health information with you at all times. If you have to go to the E.R. with a condition that is difficult to diagnose, it might help the doctor save your life.

Read another emergency room story. Or read the full article on this by Dr. Jerome Groopman in the New Yorker.

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