We, Team SAIL, have held sessions introducing social vital signs (SVS). SVS is a useful tool for evaluating patient’s social determinants of health (SDH).

BackgroundThere has been growing recognition that contextual factors influence the physician’s cognitive processes. However, given that cognitive processes may depend on the physicians’ specialties, the effects of contextual factors on diagnostic errors reported in previous studies could be confounded by difference in physicians.ObjectiveThis study aimed to clarify whether contextual factors such as location and consultation type affect diagnostic accuracy.MethodsWe reviewed the medical records of 1992 consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine in a university hospital between 1 January and 31 December 2019. Diagnostic processes were assessed using the Revised Safer Dx Instrument. Patients were categorised into three groups according to contextual factors (location and consultation type): (1) referred patients with scheduled visit to the outpatient department; (2) patients with urgent visit to the outpatient department; and (3) patients with emergency visit to the emergency room. The effect of the contextual factors on the prevalence of diagnostic errors was investigated using logistic regression analysis.ResultsDiagnostic errors were observed in 12 of 534 referred patients with scheduled visit to the outpatient department (2.2%), 3 of 599 patients with urgent visit to the outpatient department (0.5%) and 13 of 859 patients with emergency visit to the emergency room (1.5%). Multivariable logistic regression analysis showed a significantly higher prevalence of diagnostic errors in referred patients with scheduled visit to the outpatient department than in patients with urgent visit to the outpatient department (OR 4.08, p=0.03), but no difference between patients with emergency and urgent visit to the emergency room and outpatient department, respectively.ConclusionContextual factors such as consultation type may affect diagnostic errors; however, since the differences in the prevalence of diagnostic errors were small, the effect of contextual factors on diagnostic accuracy may be small in physicians working in different care settings.

Introduction: Epipericardial fat necrosis (EFN) is a relatively rare benign disease that causes acute chest pain. Case Description: A woman in her 20s presented with acute left shoulder and epigastric pain. One day before presentation, she had visited a cardiologist and an acute coronary syndrome had been ruled out. The pain worsened with deep inspiration. Chest computed tomography (CT) showed a soft-tissue attenuation lesion containing a fatty centre located in the epipericardial fat at the left cardiophrenic angle. Hence, EFN was diagnosed and the pain was resolved with loxoprofen. The lesion had disappeared on a follow-up chest CT scan. Discussion: EFN is a rare benign disease that causes acute chest pain. Approximately 70–90% of EFN cases are misdiagnosed by clinicians as other diseases. Conclusion: In patients with acute chest pain, the correct diagnosis of EFN avoids unnecessary invasive investigations and reassures patients.

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A man in his 70s presented with a 4-day history of bilateral frontal headache and heaviness of the face. He was unable to close either of his eyes, to wrinkle his forehead bilaterally and to raise either corner of his mouth. The patient was admitted with a diagnosis of bilateral facial palsy. From history, epidemiology, physical and laboratory findings, Bell’s palsy was considered more probable than viral infection, Guillain-Barré syndrome and sarcoidosis. Oral administration of prednisolone, valacyclovir and mecobalamin were initiated promptly, which improved his symptoms. In areas in which Lyme disease is not endemic, we believe that Bell’s palsy is the most probable cause of isolated bilateral facial palsy. Patients with bilateral facial paralysis under the suspicion of Bell’s palsy should be immediately started on steroid therapy.