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KMID : 0383019700010010033
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Alumni Bulletin of Internal Medicine
1970 Volume.1 No. 1 p.33 ~ p.40
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Accuracy in Diagnosis of Surgical Patients in Medical Ward
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ì°êªÒÍ/Lee, Won Ro
ÚÓãùÙò/ì°ñìÐÆ/ò®çÈìé/ì°çÊéë/ùÛéËôË/ì°Îßûà/Park, Sill Moo/Lee, Joong Keun/Chee Youngil/Lee, Young Woo/Han, Yong Chol/Lee, Munho
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Abstract
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The cornerstone of Internal Medicine is correctness of diagnosis. For correct diagnosis sufficient medical knowledge, medical judgment, alertness and thoroughness of physicians as well as diagnostic facilities are required. In recent years great emphasis has been placed on the development of diagnostic laboratory tests. However, there has been little interest in a systemic analysis of the frequency and causes for diagnostic errors.
In the present study .gin analysis of 51 transferred cases. for surgical treatment over a 5 year period from Jan. 1966 to Sept. 1970 at Seoul National University Hospital. The data were obtained from a review of operative findings together with tissue diagnosis of surgical specimen as compared to clinical diagnosis.
The results were as follows:
a) Misdiagnosis was noted in 152 cases(male 88, female 64) ,out of 511 transferred cases, with diagnostic error of 29. 7%. There seemed to be some decreasing tendency of diagnostic error year after year.
b) Misdiagnosed cases were found mainly in the third, fourth and fifth decade. Cases misdiagnosed classified as to month and season were concentrated somewhat in summer and autumn, especially in July to September, revealing an indirect evidence of improper care for patients during summer vacation. The duration of hospital stay in medical ward seemed not to play a role in producing misdiagnosis.
c) Among final diagnoses(postop. diagnosis) of cases misdiagnosed clinically, neoplasm was most commonly encountered-malignancy of stomach, liver, pancreas and gall bladder in that order. The next was a various disease group including liver cirrhosis and gall stone, followed by infections and acute surgical condition. While correct diagnosis was generally preponderant over misdiagnosis in other organs, cases misdiagnosed were more than correctly diagnostic cases in diseases of biliary tract, abdominal cavity and small bowel
d) Considerable diagnostic errors seemed to be due not so much to lack of medical knowledge as to deficiency of medical judgment, alertness and thoroughness. These included failure to (1) obtain adequate history; (2) evaluate abnormal symptoms, sings or laboratory findings; (3) recognize new illness developing in the precence of a previously diagnosed chronic disease; (4) periodically review the record and repeat the physical examination.
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