Clinical medicine (London, England)
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Case Reports
Lesson of the month 2: When steroids stop working - infective endocarditis, the great mimicker.
A 63-year-old man with an extensive travel history to South East Asia presented with generalised malaise, temporal headaches and high inflammatory markers. He was treated with corticosteroids for presumed giant cell arteritis. Unsuccessful attempts to wean him from prednisolone prompted further investigations by rheumatology, haematology and finally ophthalmology. ⋯ He underwent an aortic valve replacement and completed 6 weeks of intravenous antibiotics with resolution of his symptoms. This case illustrates the importance of challenging a previous diagnosis, including repeat examination, when a patient's condition does not evolve as expected. Endocarditis is recognised as a great imitator and the diagnosis remains challenging.
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Objective To determine whether hindsight bias impacts on retrospective case note review using a five point scoring system based on modern clinical governance toolkits. Design Survey. Setting Clinicians of varying grades invited to complete a short internet survey. ⋯ Conclusion In some cases, clinicians are markedly more critical of identical healthcare when a patient dies compared to when a patient survives. Hindsight bias while reviewing care when a patient survives might prevent identification of learning arising from errors. Additionally, we predict hindsight bias combined with a legal duty of candour will cause families to be informed that patients died because of healthcare error when this is not a fact.