Patient cueing, a type of diagnostic error

Diagnostic failure can be due to a variety of psychological errors on the part of the diagnostician. An erroneous diagnosis rendered by previous clinicians can lead a diagnostician to the wrong diagnosis. This report is the case of a patient who misdiagnosed herself and then led an emergency room physician and subsequent treating physicians to the wrong diagnosis. This mechanism of diagnostic error can be called patient cuein

A coal miner with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea

Delayed or missed diagnoses are a constant hazard in primary care. This is the case report of a 51-year-old coal miner, who presented as an ambulatory outpatient on a Friday with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea. Chest x-ray on Saturday showed pneumonia and pleural effusion, while blood testing showed renal failure, but these results were not known by his physician until Monday, when he was hospitalized with severe sepsis due to fatal Austrian syndrome of pneumococcal pneumonia, endocarditis and meningitis. Analysis of the delay of diagnosis in this case suggests the possibility that a weekend effect of presentation as an ambulatory outpatient on a Friday may be a source of diagnostic error in primary care

Perioperative myocardial infarction: diagnostic clues and prevention

The diagnosis of perioperative myocardial infarction can be missed if the pain is masked by postoperative analgesia and the possibility is not considered. This report is the case of a patient with a missed diagnosis of perioperative myocardial infarction. Myocardial injury and infarction from noncardiac surgery is currently the subject of intense interest and research. This report illustrates the importance of the diagnosis and suggests clues that can be used to make the diagnosis

Death from pan-resistant superbug

Acinetobacter baumannii has emerged as a pan-resistant superbug causing fatal infections in vulnerable patients. This report is the case of an immunosuppressed transplant patient with a fatal pneumonia due to pan-resistant Acinetobacter baumannii. Alternative therapy for resistant Acinetobacter infection is currently the subject of intense interest and research. This report illustrates the features of this type of emerging infectious disease and reviews some of the novel approaches to treatment

Improving the Biblical and Spiritual Skills and Knowledge of Christian Mental Health Counselors at Grace House Counseling Center in Fleming Island, FL

Christian licensed mental health counseling at Grace House Counseling Center is a multi-faceted spiritual undertaking that is largely in the purview of lay persons who often work and minister to Christians and non-Christians who live and work in a pluralistic environment. Grace House’s mental health counselors are formally trained through their master’s degree program to provide mental health care, not spiritual or soul care, to clients. While some Grace House counselors have some spiritual training, either from an undergraduate Bible college or through years of self-study, most do not have formal training that links Scripture and spiritual disciplines to various mental disorders. Even when surrounded by fellow Christian workers, these Christian licensed mental health counselors must rely on their individual biblical and spiritual skills and training as they function as lay chaplains or lay ministers as they consult with their clients. The purpose of this Doctor of Ministry action research project is to research, develop, produce, and distribute a spiritual resource manual that will assist and equip all licensed or state-registered mental health counselors practicing at Grace House to better offer Bible-based spiritual and soul care to clients, regardless of the client’s spiritual or faith beliefs

Hypertrophic cardiomyopathy masked by pericarditis

Hypertrophic cardiomyopathy used to be regarded as a rare untreatable cause of sudden death in young male athletes. This report is the case of a middle-aged female patient with hereditary hypertrophic cardiomyopathy masked by superimposed pericarditis and revealed by autopsy. This case report illustrates how co-morbidity can hide a crucial diagnosis. This case report also illustrates the value of autopsy disclosing a familial disease that is increasingly recognized and dramatically more treatable than a few decades ago. Sudden death due to hypertrophic cardiomyopathy has become preventable, if the diagnosis is made soon enough. The lessons for patient care from this case include the importance of not missing the diagnosis of hypertrophic cardiomyopathy in female patients

How could hypoglycemia-inducing glycogen storage disease lead to hyperglycemia-induced mucormycosis?

Mucormycosis is an increasingly frequent, difficult to diagnose, difficult to treat, often fatal infection, especially in patients with hyperglycemia from uncontrolled diabetes. Type I (von Gierke) glycogen storage disease is due to inherited deficiency of enzymes in glycogen metabolism, which causes hypoglycemia. This report is the case of a patient with von Gierke disease and a missed diagnosis of pulmonary mucormycosis. This report illustrates the importance of having a high index of suspicion for mucormycosis in the appropriate clinical context

A coal miner with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea

Delayed or missed diagnoses are a constant hazard in primary care. This is the case report of a 51-year-old coal miner, who presented as an ambulatory outpatient on a Friday with weakness, fatigue, nausea, fever, chills, night sweats and dyspnea. Chest x-ray on Saturday showed pneumonia and pleural effusion, while blood testing showed renal failure, but these results were not known by his physician until Monday, when he was hospitalized with severe sepsis due to fatal Austrian syndrome of pneumococcal pneumonia, endocarditis and meningitis. Analysis of the delay of diagnosis in this case suggests the possibility that a weekend effect of presentation as an ambulatory outpatient on a Friday may be a source of diagnostic error in primary care