Saturday, April 23, 2022

NEVER NEVER 100%

    In medicine we go by statistics. Take a simple example of bronchitis or pharyngitis. In medicine we see a patient and if the complaints and the physical examination fit =s in to the diagnosis then we treat with antibiotics. We don't necessarily do a throat culture or blood count or X- ray etc. as investigation. We just treat it and we get to be correct most of the time . Out=r decision is based on statistics and we are correct most of the time . The bad part is nver 100 %. This is a story of a patient when we did not get to be right and still we felt good.

    I saw this patient 68 years old who was a current smoker . He had some cough and he had no other complaints. He had had chest x- ray  and that was OK but he had had a CT scan in past that had shown abnormality . The old CT scan was from 2 years old . I got hold of  the report of the CT scan and that had shown a nodule. he had not had the new or follow up scan  and so I decided to do new CT scan . The CT scan showed that the nodule had increased by quite a bit . To be exact the nodule was 9mmx6mm and now it was 16mmx11 mm We did the bronchoscopy and also did the PET scan . The PET scan uptake was mildly increased, The breathing  test showed adequate lung capacity. The PET scan uptake was minimally increased but we can see that in very slow growing cancer as the metabolic activity of theses cells is not very high and so the uptake could be low..I discussed the case with patient and the family . I also called a chest surgeon. The surgeon was sure that he had slow growing cancer and I also felt the same thing and the problem was only 100 % test is to do open biopsy. 

   He has the open biopsy and the report showed no CANCER and it was a scar with lots of inflammation. So that was good .I was happy that he did not have cancer we don't have to worry about recurrence, but we were 100 % wrong. So in medicine there is no 100 %  right or wrong!!