A propos de la discussion sur les tests th�rapeutqeus, cet extraitdu scalpel
http://www.thelancet.com/journal/vol359/iss9302/full/llan.359.9302.uses_of_error.19102.1 Uses of error Trust and responsibility Kenrick Berend In 1983, working as a resident in internal medicine, I saw an obese, 60-year-old female, patient who had shortness of breath after a cholecystectomy. She had tachypnoea, tachycardia, and some crepitations on pulmonary auscultation. Her blood gas showed hypoxia and the supine chest radiographs showed signs of redistribution. The electrocardiogram showed no signs of infarction or left ventricular hypertrophy and with confidence I diagnosed congestive heart failure. Her symptoms resolved rapidly with intravenous furosemide. I ordered a daily dose of furosemide but that week I personally injected furosemide twice to ease recurrent symptoms. I remember how grateful she was for this treatment, and she said she felt better "on the needle". I was stunned to be called on Monday morning and asked if I would like to attend her autopsy. I was terrified to notice that there was no evidence of heart failure but that she had died of multiple pulmonary emboli. With this awful memory clear in my head, I saw in 1987, at the university hospital, an inactive man with Parkinson's disease in the clinic and this time I diagnosed pulmonary embolism without hesitation. I admitted him to the hospital and the resident in charge treated him for heart failure, resulting in another visit to the morgue to see an untreated pulmonary embolism. Although I could have easily arranged a ventilation perfusion scan before admission, I trusted my colleague would treat the patient for pulmonary embolism, because I had personally discussed the diagnosis with him. In 1992, I started a non-profit dialysis clinic on Cura�ao with the help of external consultants. I was advised not to install a water treatment system because the municipal water was distilled seawater and extremely pure. However, because I trusted the water company to deliver a constant water quality, 4 years later 10 patients died of acute aluminum intoxication when aluminum leached from the cement layer of a newly-installed water distribution pipe. Trust is a dangerous companion in medicine. My trust in my own ability to make a diagnosis, in others to accept my suggestion, in consultants and the water company to do their job, has so far resulted in the death of 12 patients. Diatel Cura�ao, Jan Noorduynweg 81, Cura�ao, Netherlands Antilles (K Berend MD) -- Axel Ellrodt Essonne, France http://zzorglub.ifrance.com/ Data, medical literature and links for emergency physicians. Un site pour urgentistes Um site para emergencistas Un sitio web para emergenciologos Azee'iil'inaa biwebsite Honlap oxyologusok szamara
