The piano player and the physical examination

Recently we have been in the Diagnostic Error Meeting in Washington, DC. There the Professor of Surgery of Stanford University Dra. Carla M. Pugh,  showed the importance of a correct clinical examination and palpation to detect a lump in the breast. Force and the technique of examination is important. There is one technique what is less effective to detect a lump in the breast, the piano player technique.

We consider that this concept is also important to detect cervical and supraclavicular lymph nodes.

You can see a video here

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A picture is worth a thousand words, more if it is definitive

 

A picture is worth a thousand words

Advice: all images have the patient’s  consent

Looking for a sign

After the anamnesis and physical examination a doctor tries to figure out in his or her mind what is the problem with the patient. But, when time starts to run without a diagnosis, the patient, the Continue reading A picture is worth a thousand words, more if it is definitive

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Should we have to introduce a “Diagnosis Rescue Team” for patients?

Health systems are local, but the problems are global

Many patients and families spend several visits and time looking for an answer to their health problems.  Across this path of uncertainty, no one is able to measure the amount of anxiety, impotence, even desperation, together with a lack of information about a proper Continue reading Should we have to introduce a “Diagnosis Rescue Team” for patients?

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A new diagnosis each month (7): when a disease is not easy to frame

A new diagnosis each month (7): when a disease is not easy to frame

Clinical case

A healthy eight-year old boy started with abdominal pain , bright red stools, and mild fever(37ºC). Initially,  he was treated as a gastrointestinal  infection with diet and fluids, but the abdominal Continue reading A new diagnosis each month (7): when a disease is not easy to frame

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The Indirect Diagnosis, or can we call it “ex juvantibus”?

This post is dedicated to the memory of   FPJ who worked as a nurse and who decided to share with me her brave and realistic attitude during the course of her disease. She was also an example  across the diagnostic process . She decided to share with me and the Foro Osler her history. Thank you.

Continue reading The Indirect Diagnosis, or can we call it “ex juvantibus”?

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Improving Diagnosis and Clinical Practice