Medical Diagnosis: Just Another Service I Offer

Last night around 1:15, Sophia woke up crying. She didn’t know why she was crying, she just knew she couldn’t stop. She had a lot of head congestion which of course was made worse by her being upset. I tried giving her medicine, laying down with her, giving her a drink of water, pretty much everything in my bag of tricks. Still she kept crying.

I was afraid she was going to wake up Trevor and/or keep Dan awake, so I took her out to the den (at the opposite end of the house) and laid across our big leather chair with her. She was mostly laying down, but her head was more upright than it would have been in bed. After she finally stopped crying, she managed to fall asleep. I waited a little while, then took her back to her bed and she slept the rest of the night without incident.

To most people, that might just seem like a fluky little incident, but coupled with the fact that she’s had a runny nose for the past two days, to me it meant that she had an ear infection. No fever, no complaints of her ears hurting, but I was betting that it was an ear infection. Every time that girl has had a runny nose and disrupted sleep patterns, she’s had an ear infection.

So, first thing this morning, I called the doctor for an appointment. When I got there, Doc asked me the usual questions. Is she running a fever? No. He looked at Sophia and asked her if her ears hurt. No. Well, what’s the problem? She has a runny nose and she didn’t sleep well last night. (I know it sounds stupid, and I felt stupid saying it. Of course, the fact that he was looking at me like I was stupid didn’t help.)

He checked her breathing, looked in her throat, and then her nose. He looked in the left ear, and then the right. As he peered into the right ear, he said, “There it is.” Turns out she does have an ear infection. He said that on a scale of 1-10, it was about a 4 and that by Saturday night it probably would’ve been full blown. I said that was why I had called today. No way am I heading into a 3 day weekend with a kid who has an ear infection and is up half the night.

So, it just goes to prove, sometimes Mom knows best. I don’t have a medical degree or even a science-heavy education, but I know my kids like the back of my hand, and I think that qualifies me as an expert, at least where they are concerned.

http://gloriana.wordpress.com/2007/01/12/dr-mom/

RRC Lecture: Intuitive Medical Diagnosis

Larry Burk, MD, President of the Rhine Research Center Board of Directors is a musculoskeletal radiologist who has worked with a number of local and national medical intuitives. Dr. Burk was former Director of Education at the Duke Center for Integrative Medicine, and is now President of Healing Imager, Inc., in the private practice of teleradiology. He has made presentations on intuitive diagnosis at the NIH, the Parapsychological Association and the American Holistic Medical Association. Larry has been interested in this subject since Caroline Myss did a reading on one of his MRI patients in 1992. In 2001, he did a small pilot research project with John Palmer, Ph.D., at the Rhine Research Center, testing seven local intuitives.

This presentation will consist of an historical overview, a summary of research studies, and a brief introduction to the experience of intuitive diagnosis for the audience through a partnered exercise.

For directions to the Rhine Research Center or the Stedman Auditorium, and/or to register, call 919-309-4600, between 9 am-5 pm, Monday-Friday, or visit The Rhine website at www.rhine.org.



http://publicparapsychology.blogspot.com/2007/02/rrc-lecture-intuitive-medical-diagnosis.html

Medical Diagnosis and Software Diagnosis

Interesting article in The New Yorker about how doctors think when they diagnose illness, or to quote the article, "the process by which doctors interpret their patients' symptoms and weigh test results in order to arrive at a diagnosis and a plan of treatment". The author, Jerome Groopman, makes the point that medical school students spend a lot of time memorizing facts, and a lot of time learning applications of those facts, but not a lot of time thinking about how to ensure they make correct diagnoses.

He describes three types of errors. The first is "representativeness", being overly influenced by what is typically true: "[Doctors] fail to consider possibilities that contradicts their mental templates of a disease, and thus attribute symptoms to the wrong cause." The example given was a very fit man who came in complaining of chest pain, but not the pain normally associated with coronary-artery disease; as a result the doctor was assuming that everything was OK, and was surprised when the patient had a heart attack the next day (like every patient discussed in the article, he survived).

The second type is "availability error", "the tendency to judge the likelihood of an event by the ease with which relevant examples come to mind." In the example, a doctor who had recently seen a lot of patients with pneumonia was quick to diagnose a new patient with it, even though she actually had aspirin toxicity. He over-emphasized the symptoms which were associated with pneumonia, and ignored the ones that were not, because pneumonia was the diagnosis that came to mind (the article also mentions that psychologists call this "confirmation bias", "confirming what you expect to find by selectively accepting or ignoring information"; I'll ignore the obvious political comment that could be made here).

The third type is "affective error", making decisions based on what we wish were true. In the example cited, a doctor had failed to perform a particularly embarrassing examination on a patient because he liked him personally, and was hoping that he did not have an infection.

There's an interesting quote about how doctors begin diagnosing patients as soon as they meet them: "Even before they conduct an examination, they are interpreting a patient's appearance...Doctor's theories about what is wrong continue to evolve as they listen to the patient's heart, or press on his liver. But research shows tht most physicians already have in mind two or three possible diagnoses within minutes of meeting a patient, and that they tend to develop their hunches from very incomplete information."

What this made me think of is how developers approach debugging software (it also made me think, to a lesser extent, about how we approach interviewing). Although debugging is not the life-or-death situation that medical diagnosis can be, and there are ways in which debugging software can be both harder (computers can't tell you how they feel) and easier (we can look as deeply as we want into a computer), there are some aspects that are remarkably similar (such as "it doesn't happen in my office"). Working in an emergency room with a patient who is in critical condition has some (note that I only said some) of the pressue of working in a build lab trying to figure out why the new build of Windows is crashing in your driver. Programmers do start out with a hypothesis based on the early symptoms reported, and then set about proving or disproving that hypothesis. The mistakes of representativeness, availability errors, and affective errors remind me of mistakes I have made while debugging, for similar reasons.

And I think that the cognitive dimension of debugging has been just as ignored as the cognitive dimension of medical evaluation. The medical school tenet of "see one, do one, teach one" accurately describes the way in which debugging knowledge is learned and passed on by developers. Doctors are starting to look into how doctors think (search for the name "Pat Crosskerry" to find some of this); I wonder if someone has, or will, look into how programmers think.

http://www.proudlyserving.com/archives/2007/01/medical_diagnos.html

The benefits of ultrasonography in diagnosing appendicitis

Doctors know nowadays that diagnosing appendicitis is most easy and most difficult at the same time. Symptoms like pain around the navel, nausea, vomiting can also be caused by other disorders in the abdominal area. The pain in appendicitis localizes in the right ileal fossa where a sensation of tenderness and discomfort occurs due to the implication of the peritoneum.

Blood testing is usually of little value and can mislead the diagnosis. The base of diagnosing appendicitis remains the clinical exam done by the surgeon. But precisely the clinical examination can be sometimes mistaken as the variety of symptoms can mislead you easily.

Wrong interpretation of signs often makes a surgeon remove a normal appendix or delay the removal of a perforated one. Further complications like peritonitis, infection and longer hospitalization period needed, appear either due to late presentation of the patients in hospital or because of doctor’s hesitation in establishing a diagnosis. Because of the dangerous sequels normal appendix removal must be avoided.

In the last two decades, certain new scoring systems have improved the clinical performances in establishing diagnoses although the general results were manifold. According to studies, mistaken diagnosis by young doctors has decreased from 42% to 29%, and perforation cases dropped by 50%.

The precision of medical conclusions increased though the new discovery more than due to the Alvarado scoring system that calculates the susceptibility of a person to develop appendicitis by several clinical references. The new technology using computers seemed to promise a most accurate diagnosis, but the normal appendectomy was still 15-30%.

In a study using ultrasonography combined with the Alvarado score, no major benefits occurred compared to the unassisted clinical judgment. Both camps showed an about 12 percent of mistaken diagnosis owed to normal appendix or late surgery of a perforated one. Echography, even when performed by most experienced clinicians gives a rate of 5% false positive diagnoses.

The question whether ultrasonography should be rarer used because of the cases that could have been better interpreted by clinical judgment, persists. The answer is dual, as ultrasonography sometimes proves itself vital when establishing a prompt diagnosis and thus reducing morbidity.

Recent research showed no necessity of routine ultrasonography in patients with clear signs of appendix inflammation, as it can only mislead surgeons by showing a false negative image. No clinical benefits can be provided by performing an echo to all hospitalized patients.

The importance of ultrasonography appears in uncertain cases and diagnoses, when the clinical judgment must be doubled by Para clinical technology. On the other hand a negative result from the Echography shouldn’t make a doctor send the patient home; clinical abilities are still the most important in diagnosing.


For more resources about acute appendicitis or even about appendicitis please visit this website http://www.appendicitis-center.com/

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The Complexity of Autism and Issues in Diagnosing the Syndrome

Autism has drawn the attention of many medical scientists throughout the course of history. Fascinated by the various levels of impairment determined by this complex neurological disorder - behavioral, emotional, communicational and cognitive, scientists have tried to clarify the notion of autism and its revealing signs. The most exhaustive research conducted upon this type of disorder belongs to Leo Kanner, an Austrian psychiatrist that focused on the study of autism and other related disorders. Kanner was the first scientist to establish an elaborate description of the disorder which he referred to as a syndrome.

In the 40's, Kanner came up with a clear model of diagnosis for autism, based on various experiments and elaborate research. Although Kanner's model of diagnosis is relevant and complete, nowadays it can also be confusing in the process of diagnosing autism. Therefore, various contemporary medical scientists had focused their careers on improving the model of diagnosis introduced by Leo Kanner, clarifying certain obscure aspects that he presented in the past.

It is very important to understand that people with autism don't follow the same pattern of impairment, and in fact, the development of the syndrome can greatly vary from a person to another. The severity of autism can alternate from mild to very pronounced and the syndrome can affect people on multiple levels. It is very difficult to correctly diagnose people with autism, as the syndrome can generate a multitude of abnormalities that might point to other neurological disorders. For instance, while some people with autism may present a pronounced impairment of their social skills, they may have an average emotional IQ and a high performance IQ. Other people with the syndrome may have a low performance IQ, but they may present higher levels of emotional intelligence and better social skills.

When Kanner first established his model of diagnosis, he stated that the disorder is very complex and its margins are very difficult to identify. Hence, he invoked that autism can affect some levels more than others. Kanner's model of diagnosis presented these following features:

- Impairment of social skills, from early childhood to maturity;

- Impairment of communication skills, which can vary anywhere from complete inability to develop speech to poor ability of initiating and maintaining a conversation. Kanner also noted echolalia and excessive questioning as autistic features;

- Very low responsiveness to external stimuli, exaggerated preoccupation with repetitive activities, stereotype behaviors;

- Good cognitive skills and memory;

- Good physical skills and muscle coordination.

Considering the fact that Kanner didn't clarify many aspects of the syndrome, contemporary medical scientists have focused upon simplifying his model of diagnosis. Although the features and the patterns of autism described by Kanner have been preserved, modern science attempted to establish clear criteria of diagnosis. Furthermore, in the late 70's, Rutter developed new controversial theories, claiming that autism shouldn't be separated by performance intelligence in the process of diagnosing the disorder.



So, if you want to find out more about Autism, and especially about autism symptoms or autism symptoms checklist, please click one of the following link.

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Do I Get My Child Diagnosed?

This is a question that parents of children they think may have social difficulties have to ask themselves. And it is a really difficult question to answer.

The type of questions that parents ask themselves:

� Why does my child need to be diagnosed?
� How is an autism diagnosis going to affect my child in the future?
� Am I labelling my child?
� What will happen after I get my child diagnosed?
� Can the diagnosis be removed?

The route for a diagnosis starts when parents believe their children may have a social problem. The likelihood is that they will look up a set of symptoms from a doctor or from the internet and try and match the child with the different types of behavior. Once the parents are fairly sure that their child fits a certain condition, they then look for some confirmation. This is where the difficulties start, because there are very few ways to get any definite assessment without actually diagnosing the child.

If you do have an assessment done which says that your child does have a social disorder, then you are faced with the question, do you get a formal diagnosis? The way parents have their children diagnosed is typically done by a specialist or group of specialists that assess them against a set of behaviors and abilities. If the child fits a certain number of behaviors or abilities then they can be formally diagnosed as having a social disorder or syndrome.

Here are some benefits and disadvantages:

Benefits

� Once you have a diagnosis you can move on and stop guessing
� Helps parents to know how to deal with the condition
� Helps Specialists and teachers to deal with the child in the correct way

Disadvantages

� Possible label they will have forever?
� Can be used as an excuse for blaming the child (e.g. at school or with siblings)
� Is it necessary? Especially when dealing with high functioning autism
� The diagnosis is subjective and may not be accurate

Getting a diagnosis is very much a decision for the parents and should be considered in detail if the child seems to be a borderline case. The best thing to do is to face realities about your child and whether they really need help. If they do then you could be making an important step forward in getting your child diagnosed because a diagnosis will probably lead to a clear plan of development. On the other hand you must not let a diagnosis be in vain.

Give it time and avoid making hasty decisions. If you feel a sense of time running out then you probably need a diagnosis to help you move on. You must also be open minded, don't make decisions based on emotion but remain factual and clinical about it. If you can do these things then you will be making the right decision.

Ben Sidman is a Parent of an amazing autistic child and founder of http://www.autism-support-community.com - an informative and friendly web site for parents with autistic children.

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Difficulties in Diagnosing Lupus

Due to its polyvalent character and its intrinsic nature (lupus is triggered and augmented by severe immune system impairments), lupus is very difficult to diagnose accurately and promptly. In some cases, the complexity of lupus renders doctors unable to reveal its presence in time, the unspecific symptoms produced by the autoimmune disease often being misleading in the process of establishing the correct diagnosis. It may take months or even years to confirm the diagnosis received by patients with suspected lupus. The process of diagnosing lupus can be challenging even for the most experienced doctors. Patients can also influence the duration of the process of diagnosis, as doctors often rely on symptomatic reports apart from common laboratory analyses and physical examinations. The challenging process of diagnosing lupus can only be accelerated and facilitated by good doctor-patient cooperation.

Although at present there aren’t any specific tests that can reveal the presence of lupus, the existing laboratory tests can still help doctors decide upon the correct diagnosis. The most commonly used method of diagnosing patients with suspected lupus consists in looking for the presence of auto-antibodies in blood samples. The antinuclear antibody test (ANA test) is nowadays extensively used to detect the presence of auto-antibodies in patients with suspected lupus. However, the main problem with the ANA test is that it isn’t 100 percent accurate. For instance, a positive result for the ANA test may be influenced by factors such as past infections, chronic diseases or prolonged treatments with certain medications and not by the actual presence of lupus. In order to confirm the presumptive diagnosis, doctors have to rely on various other tests, such as anti-DNA, anti-RPN, anti-Ro, anti-La, or anti-Sm antibody tests.

When these previously mentioned blood tests along with clinical examinations and the patient’s symptomatic report are inconclusive for establishing the correct diagnosis, doctors may decide to perform biopsies of the skin or kidneys in order to reveal clear evidence of lupus. Additional tests often include the test for syphilis, as lupus sufferers commonly have a series of antibodies that generally occur in patients with syphilis. Thus, a falsely positive result for the syphilis test is also considered to be an indicator for lupus. Doctors have to rely on a wide range of tests in order to analyze the disease from different angles and find the accurate diagnosis. Without multiple medical investigations and elaborate research, lupus is virtually impossible to diagnose properly.

Once lupus has been appropriately diagnosed, doctors still depend on a series of tests in order to identify the actual type of lupus and its rate of progression. In order to gather the required medical information, doctors may choose to perform the following tests: complete blood count (CBC), blood chemistry tests, erythrocyte sedimentation tests and urinalysis. After the results of these tests are properly interpreted, doctors can finally choose the appropriate course of medications. Due to the fact that the process of diagnosing lupus is time consuming, patients may have developed serious complications by the time they receive the appropriate medical treatment. Despite their limited relevancy, the existing procedures of diagnosis are the only means of revealing signs of lupus in patients. Medical scientists are hoping to find more efficient methods of diagnosing lupus in the near future, methods that can simplify the process of diagnosis and allow prompt medical intervention.

So if you want to find more about Lupus or more details about systemic lupus please follow this link http://www.lupus-guide.com

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