Why do we miss the diagnosis ?

Why do we miss the cases ? 

In a busy day OPD when there is burden on only one doctor in hospital, it's likely that things get missed. It was a few years back when I had to see around 100 patients in a day all alone. It was tiring and irritating too and my nerves were about to break.Besides, the postmortem in midst of the OPD added fuel to the fire. A dead person torments one more than walking patients.But the responsibility stands before anything in this critical profession  so i had to carry on and i did.

There was a 50 year old man who had estimated weight loss of almost 5 kg in a month. Few people get privilege of awareness to track one's weight. His appetite had been less than normal for a month.  However, he was not sure about fever although he mentioned his body got warmer at times. He was a non smoker. He never consumed alcohol. He looked  quite well.There was a rush in OPD,nothing special rang my bell so, I examined him superficially. 

I didn't bother much about his symptoms because he didn't look very sick. The queue was tiring so i didn't find it appropriate to keep him waiting. I asked him to track the weight, temperature and then return in two weeks. 

When he visited me after 2 weeks he had  a weight loss of 1 kg. He was not feeling well as usual. Some sort of malaise always prevailed in his body. 

That time I examined him thorougly. Guess what I found ? 

There was a 4 cm lymph node in his left axilla. On his last visit, I didn't check his lymph nodes of axilla precisely. There was no cervical lymphadenopathy. I assumed it to be enough on part of the general examination of lymph nodes. 

The neck lymph nodes are commonly involved peripheral lymph nodes.

There are about 700 lymph nodes in a human body. Out of them, cervical lymph nodes rank the highest in number of about 300. These are rough values only. So there should be chance to find the cervical lymphadenopathy more often than elsewhere. 

I sent him to get the lymph node biopsy to a medical college. Guess what was the diagnosis ? 
He had TB lymphnode. He was happy with the curability of the disease but disconsolate about the expenses in medical college. The medical colleges have been very insensitive towards common people. That may be the reason why Dr GKC declares hunger strike now and again. 

Morale: General examination is the bread and butter of diagnosis so let's not ignore them assuming them to be general.

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