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Jonas Brachfeld, MD
Rancocas Valley Division Zurbrugg Memorial Hospital Willingboro, NJ

JAMA. 1984;252(21):2957-2958.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The recent correspondence in THE JOURNAL¹ regarding failure to diagnose acute myocardial infarction prompts me to make the following comment. I have had the opportunity to collect data on a number of cases of missed myocardial infarction that had a fatal outcome and eventually came to litigation. Since my previous reporting of this experience,^2,3 I have reviewed several dozen more such cases. The process of selection of this series is entirely different, of course, but since the ultimate criteria are highly restrictive (fatality and litigation), these cases probably reflect the tip of the iceberg.

One factor recurs monotonously in many cases. The diagnosis was missed because of excessive reliance on specific history (such as the nature or the radiation of the pain), physical examination, or laboratory findings. Not enough weight was given to the circumstances under which the patient came to medical attention. For example, . . . [Full Text PDF of this Article]

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