Medical report

“ The later and better knowledge of the real nature of fever cases has been obtained by a similar range of observation gained from the cases in fever hospitals. Applications have been several times made to the Commissioners by medical men engaged in particular researches to aid them in the removal of the impediments to extended inquiry, by collecting the information to be derived—from the sick-wards of the workhouses and the out-door medical relief lists. ”

“ Biological monitoring aims at protecting the health of specific groups of workers who, because of the nature of their jobs, are particularly vulnerable. The monitoring take the form of periodical medical examinations and may include chest X-rays and laboratory investigations. ”

“ From year to year the statistics of the most common diseases must be revised in the light of new conceptions of disease. Through the autopsy there lies within the reach of every practitioner the opportunity of contributing something worth while to the general sum of medical knowledge. ”

“ Medical observation is ever incomplete, unless it take cognizance of all the functions, the aggregate adequateness of which, respectively ascertained, constitutes and is essential to health. The state of each should be accurately examined, however unconnected it may appear to be with the prominent derangement. Diligent scrutiny will often detect a morbid condition where it was unsuspected; and a negative should never rest on surmise wherever direct evidence is attainable. ”

“ With the abundant information, the well argued deductions and the carefully drawn up statement here placed before us it may be claimed that we are now in a position to make diagnoses that not long ago were quite beyond our reach, whilst a thorough training of our younger medical men in the methods of blood examination must result in the accumulation of new facts of prime importance both to the pathologist and to the physician. ”

“ SYMPTOMS AND PROGRESS OF DISEASE—AGE AND CLASS OF PATIENTS TO BE TREATED—OPERATION—AFTER-TREATMENT, ETC. Every medical practitioner must have met with a certain class of cases which has set at defiance every effort at diagnosis, baffled every treatment, and belied every prognosis. ”

“ Abstract 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. ”

“ Human studies of CCP have dealt mostly with exposures in office settings. Three types of human studies of CCP have been conducted: individual case studies or case series, cross-sectional studies, and laboratory studies in humans. The following sections separately review each type of study.
4.2.1 Published Case Reports and Case Series
The case report is a detailed profile of a single subject; case series describe the characteristics of a number of patients with a given disease. Case reports and series document unusual features of a disease or a patient’s exposure history ”

“ Yet there are signs that we are entering on a new phase, and that a realisation of the importance of early diagnosis is slowly permeating through the medical profession. In America we see an increasing insistence on the use of detailed and specialised laboratory methods for exact diagnosis ”

“ In private and even dispensary [Pg 46] practice, where the subjects were of a better physical and moral nature, we often saw the disease subside, and health return, after less attention to administer medical aid, or to supply other wants, than was exhibited at the hospital. We are, notwithstanding, sanguine enough to anticipate useful results from our attentive study of the symptoms of the disease, in connexion with that of the post mortem examinations, and to consider ourselves as in possession of lights to guide us with more certainty than before. ”

“ In reflecting on the state of medical science, and on the aid which it has derived from the opportunities of observation afforded by congregating the sick in hospitals, it has often struck us with surprise, that so little should be known of the many interesting cases that must have occurred in provincial hospitals. If, from the establishment of these institutions, faithful records of the valuable cases that have occurred in them had been handed down to us, our present limited knowledge of morbid anatomy, the only correct elucidator of disease, would have been greatly extended. ”

“ Broughton Brandenburg, Imported Americans, 208.
[18] This imaginary sketch adheres in every detail to the facts. The medical examiners and inspectors become exceedingly expert in detecting disease, disability, or deception. If an overcoat is carried over the shoulder, they look for a false or stiff arm. The gait and general appearance indicate health or want of it to them, and all who do not appear normal are turned aside for further examination, which is thorough. The women have a special inspection by the matrons, who have to be both expert and alert to detect and reject the unworthy. ”

“ Invasive physical examination.—The term `invasive physical examination' means any medical examination that involves the exposure of private body parts, or any act during such examination that includes incision, insertion, or injection into the body, but does not include a hearing, vision, or scoliosis screening. ”

“ For example, one not an oculist may speak as to the cause of injuries to an eye; one who has not made diseases of the mind a special study may give his opinion as to the existence of insanity; one not a practical chemist or analyst, but understanding the practical details of chemistry and the means of detecting poisons, may testify as to the tests in the chemical analysis of a stomach, and as to the tests usually applied to detect poison (278) . The law will even allow a physician to speak as to the length of time a mule has been suffering from a disease (279) . ”

“ I feel satisfied that no one who can entertain so libellous a doubt, will venture to be present this day; but if there be any one who hesitates as to the probability of the provinces containing able writers, willing to devote themselves to the cause of our science, for the pure love of truth, and for that only, I would beg to call his attention to the publication of the Midland Medical and Surgical Reporter, which commenced in the year 1828, and of which, sixteen numbers have been published. ”

“ Diagnosis of occupational diseases shall be conducted by medical and health institutions approved by the public health administration departments of the people's governments at or above the provincial level. ”

“ Article 5 Each Member which ratifies this Convention shall take measures to ensure that workers are provided with such medical examinations or biological or other tests or investigations during the period of employment and thereafter as are necessary to evaluate their exposure and supervise their state of health in relation to the occupational hazards. ”

“ We may trust that ere long the concerted action of the entire medical profession will furnish us with a constant knowledge of the comparative prevalence of all disease. In the United States the want of such a system is in a manner compensated for by the periodical enumeration of causes of death at each national census. ”

“ The clinical laboratories in the combat support, field, and general hospitals have the ability to perform a general, but limited, array of analytical procedures in hematology, urinalysis, chemistry, microbiology, serology, and blood bank. Patient specimens of suspected biological or chemical agent exposures are forwarded through technical channels to the supporting medical laboratory. See Appendix B for sample/specimen collection, packaging, chain of custody, processing, and transporting requirements. ”

“ It is imperative to create an environment or a culture that reduces stress for the physician, to always use differential diagnoses even when the diagnosis seems obvious, and to train humble physicians who are willing to listen to patients and other team members so that they can revisit the evidence when they are questioned about their diagnosis or management of patients. ”

“ The doctor who never changes his diagnosis is the doctor who never makes one, or who makes it so elastic that it means nothing. So social workers should never fear to add to, to subtract from or to modify their social diagnoses.
The best medical diagnoses—those made after [Pg 111] death—often contain fifteen or twenty items. Before death in a recent case we found pneumonia. After death we found in addition: meningitis, heart-valve disease, kidney trouble, gall-stones, healed tuberculosis, and ten minor troubles in various parts of the body. ”

“ Human Tissue Samples.—On an annual basis, the Director of NIH shall submit to the Congress a report that describes how the National Institutes of Health and its agencies store and track human tissue samples. ”

“ The more formal duty of sending to the Medical Officer of Health a certificate stating the name of the patient, the situation of the building, and the infectious disease from which in his opinion the patient is suffering, is imposed on every medical practitioner attending on, or called in, to visit the patient, on becoming aware that the patient is suffering from an infectious disease to which this Act applies. ”

“ Three physicians give their sole attention to diseases peculiar to women and three to those of the nasal organs, throat and chest, embracing all chronic diseases of the respiratory organs. Thus we have a full council of three and four physicians in these several specialties. In several other divisions we have two specialists. No case is slighted either in the examination or in the treatment. All doubtful, obscure or difficult cases are submitted to a council composed of several physicians and surgeons. Skilled pharmaceutists are employed to compound the medicines prescribed. ”

“ The data for the medical history of a man's life are the observations made by his physician in his successive illnesses, and I would dwell on the importance of gradually establishing a custom that the medical attendant of each patient should as a matter of course write down such clinical notes of his case as are written at the bedsides of public patients at hospitals. ”

“ The occurrence of three or more closely connected cases, in the practice of one individual, no others existing in the neighborhood, and no other sufficient cause being alleged for the coincidence, is prima facie evidence that he is the vehicle of contagion.
7. It is the duty of the physician to take every precaution that the disease shall not be introduced by nurses or other assistants, by making proper inquiries concerning them, and giving timely warning of every suspected source of danger. ”

“ Often the best type of clinical reports—those in which the observations are directed to the significant events and not to mere side lines, and in which the significant events are correctly and adequately reported—generally lack one important essential, namely, an adequate control of the natural course of the disease. ”

“ The treatment most generally successful may have been deduced from an extensive examination of cases faithfully and accurately recorded, and yet it may be wholly inadmissible in the particular instance in which its application is contemplated. As was before remarked, the only security against error lies in adapting the remedies not according to the name given to the disease, nor to the alleged success of former cases, but to the special derangements which prevail in the several functions of the individual frame under consideration. ”

“ However, the requirement under subsection (1) that an individual submit to a medical examination does not extend to a requirement that the individual submit to any procedure involving surgery or the injection into the body of any drug, but includes requiring the individual to undergo a breath‐analyser test or a toxicological examination or to provide blood or urine for a laboratory test. ”

“ Cases are found where the patient, possibly on the public platform or at a social gathering, is seized with a consciousness of the malady so suddenly as to render medical assistance futile. Surgical Cases It is impossible to mention more than a few of the most typical cases of diseases of this sort. ”

“ Excludes1: aftercare following medical care (Z43-Z49, Z51) surveillance of contraception (Z30.4-) surveillance of prosthetic and other medical devices (Z44-Z46) Z11 Encounter for screening for infectious and parasitic diseases Screening is the testing for disease or disease precursors in asymptomatic individuals so that early detection and treatment can be provided for those who test positive for the disease. ”

“ At a period when pathological research is lending its aid in investigating the appearances of disease in every part of the body, and many nice distinctions in diagnosis are aimed at, which are better calculated for nosological than practical purposes, it seems to me not a little extraordinary, that so few have cultivated that most important branch of medicine, the study of the diseases of children. ”

“ Clinical Evidence.—To be acceptable, the clinical evidence must offer objective data with such citation of authority as will enable the Council to confirm the facts and establish the scientific value of the conclusions drawn. Clinical data are worthless when the author is not cited. The facts on which claims with regard to the value of a remedy are based must have been rendered accessible for investigation and confirmation by disinterested observers, either through publication or through the records of a hospital or other institution. ”