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Ever Missed a Diagnosis? then Take Another History!

Neurology Service, CHUV, Lausanne; Email: Patrik.Michel{at}chuv.hospvd.ch

EXTRACT

We all worry about missing a diagnosis. Not so much because we may land up in jail or because our ego is put into question, although both may hurt. It is because we know that getting our patients better depends first on a correct diagnosis. We re-learn this every few weeks when an elderly patient in stupor arrives in hospital with laboured breathing, and the family is ready to let him or her die: this can cause prolonged suffering on all sides if one does not establish a basic diagnosis and understand the underlying cause. Another reason why making the right diagnosis helps is that neurologists have become quite good at secondary prevention – preventing another epileptic seizure, another relapse of multiple sclerosis, or another stroke. Not making the right diagnosis prevents us from preventing, and yes, we often do feel incompetent, untrustworthy, and a bad doctor if our patients come ...

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