PATCH WORK

    In our general life we are always to to make decisions as to do a 'temporary patch work or do permeant fix'. So the AC is broke and the tech tells you  we can get it working with some  minor or less expensive parts or we can change major things and that will be warrantied . With cheaper work there is no guaranty that things will last but it is less expensive.  The came thing may be for roof repair or car problems. I fell that in medicine  is the same. We see patients in office or in hospitals, that are admitted for some diagnosis and then we fix it but that does not change the underlying problems or treat it . Example will be someone admitted for pneumonia with underlying COPD in smoker . So, we treat pneumonia but the patient continues to smoke  and gets CIOPD worse. We did not address that. This is very clear cut. But I am going to tell you  the story of a patient where this extend to more that such obvious thing. 

  I have know this patient for many years. She had some COPD  and she also had some cardiac issues . She was quite obese and it was to a point that she could not get of her bed  on her own. She was admitted with swelling in her feet and she was short of breath and so she was admitted and we treated her . She had some fluid around her lungs . She was treated and then sent home . She was readmitted and has same thin  and we tried to treat her . In her 5th or 6th hospitalization, she had increased fluid around her lungs , mainly left lung. She was very heavy women. Normally I drain the fluid by inserting a needle. But I was not sure that if my needle was long enough to 'reach' the fluid . So I asked the radiologist to insert a catheter. He agreed , but when he tried to do it he could not get needle long enough and so he was not successful. I had to call chest surgeon. He did put in a catheter under anesthesia. Over period of days one day she got agitated and pulled out catheter. She was treated and discharged . She was back again with shortness of breath and she had low hemoglobin and then she was again sent home and she was  back in hospital and this time her salt in blood was low . 

   During every one of these hospitalization, the problems were same - shortness of breath, swelling of the feet ,fluid around her lungs and low hemoglobin etc. She never was able to get out of her bed , let alone getting to walk Her weight was same and she has nothing else changed . We did 'fix' the problems that we saw , but did we really FIX anything or was that the PATCH WORK - A TEMPERARY BANDAGE ?

WHAT WOULD AI DO ?

  Now a days we have news about AI - Artificial Intelligence. AI passed the Medical board- AI passed Bar examination and many other areas where AI is doing different things that we thought ONLY HUMANS can do. Sometimes we come across cases where on surface it may look same but one has to apply different approach to the differential diagnosis  and work up. That brings me to the patients for today. 

   I had seen these new patients . One was a young man who had been diagnosed with HIV and has been on medicines for last 4-5 years and had done well. But then he had some brain infection-meningitis - infection  of covering of the brain to be exact and was treated and did well. He had then pain in the belly and so went to ER and had CT scan of the belly done  and that was normal. But in the CT scan of the belly , there was some abnormality noted in lungs . 

    He was discharged and saw PCP and he noticed the abnormality in lungs and he had not seen lung specialist and so he was sent to me. When he had meningitis , he was on respirator and he had tracheostomy and also feeding tube  and he had not had CT scan of chest .So, it was difficult to know if the abnormality seen on CT scan of belly was new or old. I saw him and ordered CT scan of the chest , which was never done . That showed the same thing that was seen on CT scan of the abdomen .- he had a cavity - are of the lung where there is  lucency or air in the center of he congestion.

    I saw this second patient at the same time . Hw was 78 years old and has had minor stroke  and had some cough  and had no fever . He had cough and he had seen Primary physician and had chest X- rat done . He was treated with antibiotics and then he had no change in his cough and so had CT scan and that showed again a cavity. I saw him  and he had good oxygen and also had some cough. 

    So we have 2 different patients with same Ct scan findings , the age is different and the past medical history is also different. The etiologies of the problem could be very different in these 2 patient . In the first patient who has compromised immunity, due to HIV he could have Tuberculosis or Fungal infection etc. The older gentleman could have aspirated - food or liquid going down wrong way in the lungs instead of esophagus, leading to pneumonia and lung abscess.

   The same CT scan findings - some difference , one has the abnormality in upper part of the lung , other has it in lower part of the lung - the cause could be different and work up could be different too. Would AI pick it up ?  I did the work up and result in my future blog.