Comparison of clinical & pathoanatomical diagnoses

The comparison of clinical & pathoanatomical diagnoses finished the analysis

of clinical case. It gives possibility to influence on medical-diagnostic process,
promotes to the qualification of doctors and displays the weak sides of the
organization of medical care to the population. The compound analysis of
comparison the pathologist carries out together with charging doctors.

The all parts of the final clinical diagnose of the title page of the case history
must be compared. Only the certain nosological units of the title page of the case
history maybe compared, they cant’be substituted by corresponding symptom &
syndromes.

Such diagnoses like “Mechanical jaundice”, “Cancer of hepatoduodenal

area”, “Compression of the portal vein” can’t be used as main disease.

In comparison of clinical & pathoanatomical diagnoses there are following

criterions:

I. Coincidence of the clinical & pathoanatomical diagnoses.

II. Discrepancy of the clinical & pathoanatomical diagnoses. There are

different variants of discrepancy:

a. By nosolological principle (chronic non-specific pulmonary disease

instead Cancer of lungs)

b. By etiology (tuberculous meningitis instead of meningococcal

meningitis)

c. By localization of disease (cancer of stomach instead cancer of

esophagus)

III. Discrepancy of diseases by second disease (competitive, associated,

background disease). In case of combined disease the absence or
mistaken diagnose of one from these disease means the discrepancy of
clinical & pathoanatomical diagnoses.

IV. Discrepancy of diagnoses by important complications, which

significantly changed the course of disease or had the character of the
cause of death.

V. Discrepancy of diseases by important concomitant diseases.

 Moreover, the pathologist compares the clinical & pathoanatomical diagnoses
(main diseases) not only by nosology, etiology, character & localization of the
pathological process, but by the timely correct diagnostics, which determines the
adequate treatment & outcome of the disease.

In modern conditions there are following main causes of medical errors,

which lead to discrepancy of the diagnoses:

I. Objective causes or objective difficulties of the diagnostics:

a. The short time of the patient’s stay in the hospital (usually less than 1
day)

b. Grave condition of the patient, when the examination of the patient is

impossible because of the risk of the death

c. Absence of the means for investigations & diagnostics or when the

medical techniques gives false information

d. Compound, atypical cases, when in spite of all carried out

investigations, the data doesn’t give possibility to establish the correct
diagnose

e. The rare for this region disease

II. Subjective causes:

a. Insufficient examination of the patient; the cause of this medical error

is not only the insufficient physician’s professionalism, but
insufficient knowledge, and sometimes ignorance, negligence,
carelessness, desertion of the medical duty

b. Underestimation or overestimation of anamnesis, clinical &

laboratorial data

c. Underestimation or overestimation of the consultants diagnose or

absence of the consultation of the specialists

d. Incorrect formulating of the diagnose due to the infringements of the

rules of the logics of formation of the diagnose, non-acquaintance of
the instructive documentation, above all International Classification of
Disease, traumas & causes of death.

The entrance of the categories of diagnose discrepancy has the importance for
analysis of medical errors & making of necessary arrangements.
 There are three categories of diagnose discrepancies:

1. Cases, when the disease wasn’t determined on previous stages, and in this
medical establishment the estimation of the diagnose was impossible due
to the objective causes. (it’s necessary the careful analysis of incorrect
diagnostics on “previous stages”, which are responsible for the medical
error)

2. The disease wasn’t determined in this medical establishment due to the

insufficient patient’s examination (subjective & objective causes) in
enough time of the presence of the patient in the hospital. But the incorrect
diagnostics doesn’t influence on the outcome of the disease. It means that
diagnostic error doesn’t influence on the fate of the patient. This category
is most frequent one.

3. This category of discrepancy of diagnoses is most important. Cases, when

the incorrect diagnostics led to the incorrect medical tactics, which played
main role in lethal outcome. The errors of this category demand the careful
analysis, revealing of the medical delinquency.

The analysis of the medical errors the pathologist carries out together with
clinician, appealing the specialists of different profiles.