Diagnostic Error: Reasoning Helps to Avoid It


When we are in front of a patient, deciding about a diagnosis, our brain is integrating all the information, making a reasoning process based on a clinical pattern developed from previous experiences. But, even in the most apparently obvious situations, it is necessary to pay attention to the details, which can make us change our choice.


We will show here two clinical cases, with a group of signs and symptoms that allow a clinician to set his or her diagnostic election, but both cases have some peculiarities that should be detected in order to disentangle the clinical problem.

Case 1

A middle-age male patient had a previous diagnosis of a left non-small cell lung cancer two years ago. He was followed periodically, but one day the patient started with fever, cough and shortness of breath. A polymerase chain reaction for SARS-CoV-2 was positive. We show here the lung radiology at the time of admission to the hospital.


What information do you need to complete the patient’s clinical picture?

Case 2

A-72-year old man had a diagnosis of a limited small-cell lung cancer on his right lung two years ago . He achieved

a complete response after six months of treatment. While under surveillance, he started with a cough and sputum, shortness of breath, but no fever. Physical examination found only some crackles in the left basal lung, but he keeps a good general condition. A simple lung x-ray showed pathological images in both pulmonary bases.


Again, What information do you need to complete the patient’s clinical picture?

You can reach the explanation and comments HERE

Author: Dr. Lorenzo Alonso