Errors in Technique
II.  Errors in Judgment
III. Errors in Management
IV.  Errors in Diagnosis
V.   Errors in Communication
VI.  Hazards of Modern Technology
CASE OF THE OVERTREATED COUGH"
(from Surgical Blunders and How To Avoid Them)
A 41-year old woman saw her family doctor
because of a persistent cough.
The doctor found nothing alarming on physical
examination, but elected to have a chest x-ray done. The x-ray
showed normal lungs, but the radiologist noted an apparent
bone tumor in the right proximal humerus.
The patient was then referred
to a major medical center for a thorough workup, including
CT scan. On her initial physical examination, she was found
to have a lump in her breast and it was elected to biopsy
that first. The breast lump proved to be only a fibroadenoma,
but the incision for the biopsy became infected, eventually
resulting in an unsightly scar.
Results of the CT scan suggested
that she probably had a benign cartilagenous tumor of bone,
but it was believed desirable to confirm that with a biopsy.
That biopsy confirmed that the tumor was, in fact a benign
cartilagenous tumor that required no treatment. Unfortunately,
the wound incision in the arm also became infected, and, in
addition, she developed a prolonged radial nerve paresis.
Somehow, during all these
therapeutic misadventures, the patient's cough spontaneously
resolved. However, she was treated for two other, asymptomatic
conditions, neither of which would have been discovered had
she not gone to her physician with a cough. She probably would
have been much better off had they not been discovered.
This case once again illustrates
the point that it is very difficult to make an asymptomatic
patient better, but it is very easy to make one worse.