Comments on: An Intersting Case that was Missed! http://pagalavan.com The Day After Tomorrow Thu, 23 May 2013 03:53:27 +0000 hourly 1 http://wordpress.com/ By: Shermaine http://pagalavan.com/education/an-intersting-case-that-was-missed/#comment-10734 Mon, 13 Feb 2012 09:54:03 +0000 http://pagalavan.com/#comment-10734 Thank you for sharing the case. I totally agree with you regarding the importance of history taking. I am a MO currently serving a rural Klinik Kesihatan. We only have very basic lab support and do not have x-rays service at all. Most of the time we have to diagnose cases base on history and physical examination and I personally feel that we can diagnose more than half of the cases base on history alone (what I mean is a good history). This is even worse when we go for flying doctor service as no investigations at all can be carried out in the field.
As in this case I personally encountered once in which my mother was the patient. She was initially diagnosed with early stage of large B cell lymphoma by a haematologist after discovering a lump at her gluteal region and staging CT and MRI were done (but no brain scan was done initially). Shortly after that, she developed depressive symptoms including poor eye contact, having low mood most of the time, anhedonia and other depressive symptoms. She had no neurological signs at all (physical examination was conducted by myself as well as the specialist in charge) and therefore, she was treated as depression (she also had past history of depression). During that time, she strongly refused chemotherapy and everyone thought that she was in denial and tried to counsel her but within a week time, her condition deteriorated and when she was referred to the psychiatrist, she was thought to be melancholic because she refused to talk, eat and ambulate. As a routine for psychiatry, they need a brain scan to rule out organic cause and the CT brain unexpectedly (atleast for me) showed some finding and they proceeded with MRI brain. However, she deteriorated very quickly and passed away even before the MRI report was out. Her final report stated that there were some suspected lymphoid filtration of the brain matters.
I think in this case, I had not asked myself enough “why” and I missed the big picture of it.

]]> By: Pagalavan Letchumanan http://pagalavan.com/education/an-intersting-case-that-was-missed/#comment-1266 Wed, 12 Jan 2011 05:44:28 +0000 http://pagalavan.com/#comment-1266 Well, I never bothered to find out his/her name. The signature is not readable as usual.

]]> By: Hamidah Marican http://pagalavan.com/education/an-intersting-case-that-was-missed/#comment-1256 Wed, 12 Jan 2011 01:10:48 +0000 http://pagalavan.com/#comment-1256 Hi Doc,
I am not a medical doctor – your article is really good. I observed residents in the US recently, and the amount of patience with which they ask for history of the patient–their supervisor told me that good history taking is the basics of being a good doctor–what is ahppening to our local doctors-in-training?? Tell me the name of this “doctor” who has a “tidak-apa” attitude. I would not ever want to see him!

By the way i find your articles very good..

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