Missed diagnosis of amoebic liver abscess: a case for forward clinical reasoning

Abstract

Background: Increasingly, a wrong diagnosis is made and wrong investigations and treatment ordered, because the doctor uses one or two symptoms to jump into a premature conclusion, without consideration of the totality of a patient's presentation. This is not forward clinical reasoning. Forward clinical reasoning is based on a systematic approach to patient's problems. The objective of this paper is to use a real case to illustrate the pitfall in ignoring forward clinical reasoning and how forward clinical reasoning serves the physician's and patient's interest better.

Method/Result: The case of a 3 year old who had amoebic liver abscess but was wrongly diagnosed and treated for lobar Pneumonia with pleural effusion is highlighted. The sequence for forward clinical reasoning is used to show how the right diagnosis could have been arrived at.

Conclusion: The correct diagnosis following sequential forward clinical reasoning saves time, money and life.

Nigerian Journal of Medicine Vol. 15(2) 2006: 170-171