Up to now we were using the word ‘mismatch’ in the medical diagnosis of pulmonary embolism, which is diagnosed by a mismatched ventilation perfusion scan, an investigation, which is not only costly and time consuming but not available in most hospitals. Today, I have stopped asking for this test and I diagnose pulmonary embolism by blood tests like D-Dimer and Spiral CT angiography of the chest.

But I cannot forget the word ‘mismatch’ which should be continued in our practice.

The following are examples in two situations:

1. Day by day we are using drugs like ACE inhibitors and ARB in patients having severe hypertension and mild CRF. Yet we know that these drugs can increase blood creatinine and potassium levels.
   So how do we diagnose the side effects of these drugs in the long term. It is only when you see the reports of blood creatinine, urea and potassium levels, which appear mismatched that you think of an iatrogenic cause.
2. On half a dozen occasions I have had instances of patients, where the gastroenterologist had advised liver biopsy because of constant abnormal liver function tests lasting for months and months.

It is only after seeing a mismatched liver function test report (mismatch between SGPT and bilirubin level) that I coaxed out the history of these patients, that they were on long term ‘statin’ therapy. They were so used to taking these drugs as a routine that they did not even think it worth mentioning to their doctor. Their so-called “illness” made by gastroenterologists, which was based on repeated SMA 12 yearly reports, was iatrogenic!!