Perform a quality assessment of the medical terminology used by identifying one or two terms that may be inaccurate or confusing within the context of the case presented.
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- Read through the case to understand the medical situation, the terms used, and the context in which they are applied. Show more…
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After reviewing the Outpatient Office Encounter of Elaine Markus (Case Study 1) and performing a quality assessment of the medical terminology used, I have identified one or two terms that may be inaccurate or confusing within the context of the case presented. In order to use this for one post, you must answer all three parts (1a, 1b, 1c) of the question. Your post must be 150+ words. Please list those terms that could be confused and describe why these terms might confuse someone. Additionally, provide a real-life scenario where one of these terms was misunderstood and the negative consequence that occurred.
Sri K.
A cancer diagnosis leads to tears and heartache. But is it correct? Dr. Paul Griner, Professor Emeritus of Medicine at the University of Rochester, presents this case study for the IHI Open School. The Case In How Doctors Think, author Dr. Jerome Groopman reflects on the reasoning process that doctors use to arrive at a diagnosis. He refers to the problem of physicians becoming "locked in" to a diagnosis so early in the process that they overlook the important clues. The result, very often, is an incorrect diagnosis and inappropriate treatment. The best example I can recall involved my twin brother, John. He had developed a chronic pain in his right hip and was referred to an orthopedic surgeon for advice. The surgeon obtained a CT scan of the hip. It showed some activity at the head of the femur, suggesting the possibility of a cancerous growth. My brother called me from San Francisco (he was on a business trip) and I advised him to arrange a visit with an oncologist at the university hospital located in his hometown. I flew up to be with him during a day of consultations and examinations. The oncologist, with knowledge of a possible malignancy involving the head of the femur, ordered a new CT scan of the hip. It showed evidence of increased blood flow, furthering the conclusion that there was a tumor. At that time, I asked whether the pain could be due to aseptic necrosis (bone death caused by poor blood supply) of the hip. The response: "Oh no, the nuclear scan would not light up like this. It would be just the opposite." A chest x-ray was obtained as part of the workup for presumed metastatic carcinoma. The radiologist noted numerous tiny densities throughout both lungs. Equipped with the referral note from the oncologist and the interpretation of the CT scan, he said to me, "This has to be metastatic carcinoma." Late in the afternoon, the oncologist informed John that all findings indicated a cancer that had traveled to his bone and lung. (The three main cancers in men that metastasize to both bone and lung are prostate, lung, and lymphoma.) A biopsy of the hip lesion was arranged, and we returned home where John sat down with his family and shared what the doctors had said. He told everyone that he had enjoyed a good life and was ready to die. Many tears were shed. But John looked very healthy for a man with a tumor that had metastasized to his lungs and bone. Except for his hip pain, he felt well. Sure enough, when the biopsy was done, there was no cancer found. Evidence of aseptic necrosis was found, however, which was healing spontaneously. This explained the findings on the CT scan. Again, there was much cheering and more tears among the family members—this time, though, it was tears of joy and relief. (The report of a chest x-ray taken some years earlier in another city was tracked down and found to be identical with that of the current chest x-ray—findings thought to be scarring from old granulomas, small areas of inflammation due to tissue injury.) Within a matter of weeks, John's hip pain disappeared. Discussion Questions What information did the oncologist likely have available which, on further reflection, might have prevented him from reaching a premature conclusion that the patient had metastatic cancer? Pretend that you are the oncologist. What would you have done first after receiving the information about the possibility of the cancerous growth? How would you follow-up with the patient after learning that there was no cancer found? Would you acknowledge the error of a premature diagnosis of cancer? Why or why not? Have you ever seen a similar example of a hasty, incorrect diagnosis? What happened? What was the result? Did Dr. Griner himself contribute to a premature diagnosis by arranging an appointment with an oncologist in lieu of a visit with the patient's personal physician—a person who knew his medical history?
Alexander B.
Blood Disorders Sometimes the body mistakes its own tissues for foreign matter. These mistakes are called autoimmune disorders. Instructions Review Chapter 40: Hematology and the following case scenario: The providers at the North Side Hospital often order hematologic tests to assist in diagnosing and treating patients. As a medical assistant, Serenity, CMA (AAMA), uses her knowledge of hematology every day. Serenity is comfortable performing waived tests because she understands the purpose and procedure of the tests. As a competent professional working within her scope of practice, she always follows all safety and quality control guidelines to protect herself and others. She also is careful to ensure the accuracy of test results. Today is busier than usual at the office and Serenity is performing an ESR for patient Edgar George (male patient in his late 30’s). Dr. Latey calls Serenity to help him perform a venipuncture for another patient, George Duncan (male patient in his early 20’s). She quickly completes the order and sets the vials down. She is then called by Dr. Bernard to perform a microhematocrit on another patient. She then realized that she forgot to label the vials for blood draw, and they have been sitting for over 20 minutes and she needs to spin them in the centrifuge. She also hurriedly placed the sedimentation rack on top of an incubator in the sunlight by an open window and leaves to finish labeling her tubes and to fill out the requisition form for the patient before she forgets. Discuss the following: Based on the case you just read, as an initial contribution to this forum, identify what processes Serenity performed, explain if there was an error in those processes, and state what you would have done in her position. To close, exchange ideas with at least two of your classmates about whether or not you believe that the test results will be affected. Discuss possible consequences for the patient and the medical office, and what you would have done if you were Serenity.
Crystal W.
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