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SOME COMMON DISEASES MISSED EVEN BY SPECIALISTS - WHY?
O P Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai,
Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
I would like to discuss diseases which are diagnosed only by history taking and examination and having no straight forward test for making a diagnosis including an Executive Health Profile.
Iatrogenic illnesses are one of the commonest examples. The reason is that a GP cannot remember thousands of names of drugs. The patient who has been taking the drug for years, forgets to divulge the history, that he is on drugs! Thus oedema or headaches due to Nifedipine group of drugs can be easily missed.
Acute attack of Gout is more often missed. Vice versa because of elevated uric acid, most of the joint pains are wrongly diagnosed as "Gout" and are prescribed a wrong dose of Allopurinol 100 mg OD or BD, when the minimal dose for real gout patients is 300 mg OD. Acute Gouty arthritis has got typical signs of a pyogenic inflammation, e.g. pain, severe tenderness of the joint involved,acute onset, the erythema of the skin, leucocytosis and even the aspirated fluid looks like pus but alas,the sample is never sent for uric acid crystal examination, because the serum uric acid is normal!!!
Acute appendicitis is another example Pain often starts in the epigastrium and later is around the peri-umbilical area. Vomiting is often absent.Leucocytosis is often absent. Compression sonography of the appendix, spiral CT Scan and a colonoscopy give misguiding results. In fact, thediagnosis is clinical and only by "exclusion"method!!
Finally, I saw this young patient with oedema of the feet extensively investigated to exclude cardiac, kidney, liver and nutritional problems, till he developed oedema of the right hand. Three anaesthetic patches on the legs, arms and the forehead led to a proper diagnosis of Hansen's!! The busy practitioners have no time to do a detailed general examination!!!
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