临床上并非疑难病例才会出现误诊。其实,贻害最大的是多发病、常见病的延误诊断(或错误诊断),尤其是把某一种多发病、常见病错诊为另一种多发病、常见病则危险更大,甚至造成难以挽回的后果。如果说,由于技术水平的差距,辅助检查不全,或是少见、罕见病而认识不清以致误诊,这就是个经验累积的问题。只要仔细观查、认真思考,结合病例查找必要的资料,或向同行请教,有可能找到答案。但如果是马虎了事,处方一开万事大吉,这就是责任心的问题,也就是医德问题了。本文介绍的病例,之所以误诊有很大成分属于后者。胸腔积液是一个常见病,做为一位内科医生,如果考试题目是胸腔积液,那末从定义、病因、机理、以至症状、体征、治疗是都能背下来。为什么这几例出现误诊,归纳起来有几点值得注意:1.基础知识差、对疾病的发生、发展及整体过程缺乏全面认识;2.对机体是一个整体认识不足,对症状只求片面解释,因此右季肋痛则为肝炎,凡有纳差即是胃炎。只是单打一的诊断意识,而不能把症状表现整体性的横向联系起来;3.体检基本功欠缺,最基本的四步手法也未认真掌握,更没有认真应用。4.责任心是工作成效的根本保证.尤其是对患者更应多问几个为什么,更应绝对负责的细微观察.用药效果不好,为什么?症状出现变化,为什么?出现与原诊断不符的征象为什么?做为一位内科医生,并非一开处方就万事大吉,关键是开过处方之后患者的反应如何。 Clinically not difficult cases will appear misdiagnosed. In fact, the hardest hit is frequently-occurring disease, the diagnosis of common diseases (or misdiagnosis), especially one kind of frequently-occurring disease, common disease is diagnosed as another frequently-occurring disease, common diseases are even more dangerous and even difficult to cause The consequences of redemption. If we say that it is a matter of experience accumulated because of the difference in technical level, the incompleteness of auxiliary examinations, or the infrequent acquaintance of uncommon and rare diseases. As long as the careful observation, serious thinking, combined with the case to find the necessary information, or to peer advice, it is possible to find the answer. However, if it is sloppy, the prescription of everything down, this is the issue of responsibility, that is, the issue of medical ethics. This article describes the case, the reason why the misdiagnosis has a large component belongs to the latter. Pleural effusion is a common disease, as a physician, if the exam is the subject of pleural effusion, then the definition, etiology, mechanism, and symptoms, signs, treatments are able to back down. Why do these cases appear misdiagnosed, to sum up, there are several points worth noting: 1. Poor basic knowledge of the disease’s occurrence, development and the overall lack of comprehensive understanding of the process; 2. The body is a lack of understanding of the symptoms only for a one-sided explanation , So the right quarter of the rib is hepatitis, where there is anorexia gastritis. Only a single diagnosis of a diagnosis, but can not be integrated horizontal symptoms; 3 lack of basic medical examinations, the most basic four-step approach has not yet seriously grasp, but did not seriously apply. 4. Responsibility is the fundamental guarantee for the effectiveness of the work, especially for patients should be asked why a few, but should be absolutely responsible for the subtle observation. Medication is not good, why? Symptoms change, why? Why is this symptom? Being a physician is not the only way to get things done when the prescription is first prescribed. The key is how the patient responds after the prescription has been taken.