Share
Disease is arguably defined as a maladaptation to the environment. Given this concept, one might consider the environment as well as the patient in looking for a diagnosis -- the other side of the coin, if you will.
The environment offers many challenges: social, employment, nutrition, substance abuse, chemical toxins, packaged food additives, the pneumoconiosis, air pollution, parasitic hazards, pollens, geographic locations and even the weather and the seasons. Hippocrates did a better job of considering the environment than we do.
This week's Case 12-2014 from The Mass General Hospital famously illustrates this concept -- A 59 yr old man with fatigue, abdominal pain, anemia and abnormal liver function; Friedman, Simmons et al NEJM 2014; 370: 1542-1550 http://www.nejm.org/doi/full/10.1056/NEJMcpc1314242?query=TOC http://consortiumlibrary.org/services/ill/.
This one is worth pursuing. Read the abstract and do your own differential. Then read the case and the CPC. (sorry no autopsy) Note the number of times this patient was sent home before he was finally admitted. The pre-admission scenario may reflect the emphases increasingly placed on rapid turnover and treatment by protocol ("best evidence") without adequate diagnosis or recognition that you do not yet have one.
Disease is arguably defined as a maladaptation to the environment. Given this concept, one might consider the environment as well as the patient in looking for a diagnosis -- the other side of the coin, if you will.
The environment offers many challenges: social, employment, nutrition, substance abuse, chemical toxins, packaged food additives, the pneumoconiosis, air pollution, parasitic hazards, pollens, geographic locations and even the weather and the seasons. Hippocrates did a better job of considering the environment than we do.
This week's Case 12-2014 from The Mass General Hospital famously illustrates this concept -- A 59 yr old man with fatigue, abdominal pain, anemia and abnormal liver function; Friedman, Simmons et al NEJM 2014; 370: 1542-1550 http://www.nejm.org/doi/full/10.1056/NEJMcpc1314242?query=TOC http://consortiumlibrary.org/services/ill/.
This one is worth pursuing. Read the abstract and do your own differential. Then read the case and the CPC. (sorry no autopsy) Note the number of times this patient was sent home before he was finally admitted. The pre-admission scenario may reflect the emphases increasingly placed on rapid turnover and treatment by protocol ("best evidence") without adequate diagnosis or recognition that you do not yet have one.
No comments:
Post a Comment