One of my colleagues describes premature closure as, "You can sleep with a diagnosis, but do not marry a diagnosis until you are absolutely certain." My best guess for the diagnosis I referred to in an earlier post was actually wrong; the alternative diagnosis was correct.
For 10 days we treated the patient for a presumed infection; then we had our epiphany and realized we were dealing with a multisystem problem. I favored the wrong one, but I did not get so cocky as to not confirm the diagnosis and proceed toward an alternative diagnosis just in case.
The initial treatment for both diseases has similarities, and the patient did not suffer because we took both possibilities into consideration.
So I share an important lesson. When you think you have found the answer, ask yourself whether there are other alternatives. We did not close down our search. The alternative diagnosis fits some of the data well, but there are a few confusing clues. I think in retrospect that I did not give enough weight to one symptom that fits the new diagnosis significantly better than the first "aha" moment.
This is a treatable disease and we can expect the patient to do well. As I said in my first post, persistence trumps brilliance. We were not so brilliant as we were stubborn and persistent.
db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.