Ajayi Tokunbo, Okudo Jerome
Department of Internal Medicine, Johns Hopkins University, 55 Cedar Lane, Columbia, MD 21044, USA.
School of Public Health, University of Texas, 1200 Pressler Street, Houston, TX 77030, USA.
Case Rep Med. 2016;2016:9621390. doi: 10.1155/2016/9621390. Epub 2016 Jun 6.
Insufficient clinical data from patients is a major cause of errors in medical diagnostics. In an attempt to make a diagnosis, initial clinical information provided to the physician may be overly relied on as the only information required in making diagnosis leading to anchoring. Failure to rely on differential diagnoses in spite of new signs and symptoms or rethinking of initial hypothesis may lead to fixation on a certain diagnosis, which may lead to significant morbidity and mortality. In the event that there is an anchoring heuristic, like in our patient, it is important to consider differential diagnoses; however, it is not wrong to rely on some form of anchor. We report a case of a 62-year-old male with a history of multiple medical conditions and a history of acetaminophen overdose who presented to the hospital with large amounts of coffee ground emesis. He was subsequently transferred to the liver transplant center on discovery that he was in fulminant hepatic failure and died two days later in spite of aggressive medical treatment.
患者临床数据不足是医学诊断错误的主要原因。在进行诊断时，提供给医生的初始临床信息可能会被过度依赖，作为诊断所需的唯一信息，从而导致锚定效应。尽管出现了新的体征和症状，却未能依赖鉴别诊断或重新思考初始假设，可能会导致对某一特定诊断的执着，这可能会导致严重的发病率和死亡率。如果存在锚定启发式思维，就像我们的患者那样，考虑鉴别诊断很重要；然而，依赖某种形式的锚定也并非错误。我们报告一例62岁男性病例，该患者有多种病史，曾过量服用对乙酰氨基酚，因大量咖啡渣样呕吐物入院。随后发现他处于暴发性肝衰竭，尽管进行了积极的药物治疗，但两天后仍死亡，随后被转至肝移植中心。
