Diagnostic errors occur due to a variety of factors. This magazine article reports on the persistent misdiagnosis and ineffective treatment of Lyme disease, including how lack of a standardized test for the disease and bias affect diagnosis and treatment of this condition.
Stonington S, Coffa D. N Engl J Med. 2019;380:701-704.
The authors describe how increasing complexity and bureaucracy associated with opioid prescribing led a patient with chronic pain that had been previously well controlled on a stable dose of acetaminophen–hydrocodone for many years to experience job insecurity, withdrawal symptoms, and uncontrolled pain, which ultimately prompted him to seek opioids illegally. The authors refer to this type of harm as "structural iatrogenesis."
An elderly man with a history of giant cell arteritis (GCA) presented to the rheumatology clinic with recurrent headaches one month after stopping steroids. A blood test revealed that his C-reactive protein was elevated, suggesting increased inflammation and a flare of his GCA. However, his rheumatologist was out of town and did not receive the test result. Although the covering physician saw the result, she relayed just the patient's last name without the medical record number.
Schmajuk G, Yazdany J. Rheumatol Int. 2017;37:1603-1610.
Electronic health records have both safety benefits and unintended consequences. This review discusses safe management of rheumatoid arthritis in the ambulatory setting and highlights the need to capitalize on tools in electronic health records to enhance medication safety for the patients with rheumatoid arthritis.
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