Why Do Allergy Skin Prick and Blood Testing Results Sometimes Differ?

Image by Wolfgang Ihloff in Wikipedia For inhalant allergies, there is a high agreement (~80-90%) in results found between skin prick and blood testing . However, occasionally the results may differ quite significantly... usually in these situations, the skin prick test comes back positive for something whereas the blood test comes back negative or normal. It's also possible that both skin prick and blood testing may come back normal even if a patient is truly allergic. Why? Bef…

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Doctors Incorrectly Diagnose Symptoms 10-15% of the Time

Although we all like to think doctors are infallible... we are far from it. Studies on doctors' diagnostic skills have consistently shown error rates around 10-15% based on different approaches. Why aren't we better? It's because human biology is complex and doctors are human. When a patient comes in with a symptom... let's take dizziness ... there are numerous possible causes for this particular symptom: stroke, medication side effect, alcohol intoxication, BPPV , Meniere…

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Large Thyroid Nodules Have Higher Risk of Cancer Even if Needle Biopsy is Normal

A recent 2015 study revealed that large thyroid nodules (over 3cm) have a higher risk of cancer and that needle biopsies are not very accurate in diagnosing cancer in such large nodules. This is hardly the first study to demonstrate this. In a 2009 study , surgeons at the University of Wisconsin found that fine needle aspiration  biopsy  (FNAB) in 26 of 52 FNAB reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis after  thyroidect…

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ENT Surgeon Sues Spine Surgeon for Wrong Sided Surgery

Wrong sided surgery is extremely rare occurring anywhere from 0.09 to 4.5 per 10,000 surgeries performed. It is almost unheard of when the patient is a surgeon as well. On Nov 13, 2012, media reported that an ENT surgeon (plaintiff) sued his spine surgeon (defendant) over wrong-sided surgery. The ENT surgeon had spine surgery in 2011 for low back pain which was allegedly due to pinched nerves. The treatment called for laminectomy surgery on the right side which entails bone removal t…

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Wrong Site Surgery Performed by ENT

In 2010, an ENT performed a tongue tie release on a 5 years old child who was supposed to undergo a tongue lesion biopsy (apparently 1cm in size over the central dorsal tongue). Tongue tie release was NOT consented for nor discussed with the parents who expected a tongue biopsy to be performed instead. In the investigative report  performed by the Department of Public Health: "When the surgeon was asked whether he examined the patient in the preop area prior to the surgery, he stated…

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Tongue Taste Map is a LIE!

As children, we all learned about the 4 different taste qualities the human tongue can appreciate: salty, sugar, bitter, and sour. Savory or umami was added in 1985. " Calcium " has been proposed in 2008 as well as more recently, " fatty " taste (oleogustus). Along with the 5 (and possibly more) taste qualities we all had to memorize at some point, we also had to memorize the taste map of the tongue (yes... I know umami is missing): Well... what a waste of time to memori…

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Dr. House of TV Fame Would Never Survive in Real World

Would YOU as the patient see a doctor who is a well-known jerk, abuses drugs, gives the wrong diagnosis more often than not, and is known to like ordering very invasive tests??? Be honest... The other week, a patient with a chronic cough exclaimed to me that she wished the fictional character Dr. House of TV fame actually existed in real life, because he was somebody who can diagnose anything. I looked her straight in the eye and told her that somebody like Dr. House in the real world …

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The Doctors TV Show Does the Mouth

The Doctors TV actually got something totally right! Actually there are two segments here... One on the mouth followed by another on what happens when food/liquids go down the wrong way causing a reflexive cough . Enjoy!

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Needle Biopsy of Thyroid Masses Misidentifies 50% of Thyroid Cancers!

Surgeons at the University of Wisconsin found that fine needle aspiration biopsy (FNAB) in 26 of 52 FNAB reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis after thyroidectomy . Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%. Even for smaller thyroid masses , FNAB is still not 100% accurate with a falsely negative rate of around 10% . Why is that? Well, one must keep in mind that the…

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