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Looking Beyond the Primary Diagnosis

Posted Sep 13 2008 4:44am

A seventy-five-year old man, who had been a professional athlete, was being treated for prostate cancer that had also gone to his pelvic bone. The man had told his doctor that he was unusually tired, but the doctor assured him that was to be expected. He also told the cancer doctor that he was experiencing extreme shortness of breath, but the physician didn't seem concerned.

When the man told me about his symptons, I asked him if he had had a recent chest X-ray or seen a cardiologist. "No", he said, " I haven't had a chest X-ray or seen a cardiologist." I was appalled. I can not understand a doctor assuming that the patient's symptoms were all due to his prostate cancer. A seventy-five-year old man could have lung cancer, cardiac problems or anemia becasue of involvement of the bone marrow.

Far too often I have seen secondary symptons overlooked. I saw one youth with Duchenne muscular dystrophy who was going to the bathroom frequently. His pediatrician had not done a urinaysis or sent the boy to a pediatric urologist. I felt something unusual in the teenager's abdomen and had his mother give him a laxative and an enema and then return. There still was a troublesome fullness in the abdomen and I referred the boy to a pediatric urologist. A treatable abnomality of the kidney and urinary tract were found. The youth's pediatrician asked me how I detected this and my daughter's answer was, "Well, I bet you took a history and did a thorough physical examination!

Too often, too, I have seen biopsies signed out as the admitting diagnosis when the slides were unreadable. A sceond opinion is always needed with a serious diagnosis or unusual symtoms that don't go with the primary disease.

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