Sunday, February 17, 2019

Are you sure about that? The problem of misdiagnosis

To treat any condition, the doctor needs to know what it is. You would not expect to have your sore ankle treated with penicillin or to have an appendectomy recommended for your sore throat. While this may be self-evident, I know of at least one patient who had a normal appendix removed because the surgeon did not notice the few tell-tale blisters that were warning the careful observer that the lower abdominal pain was due to shingles! I know of several patients who were persuaded to have disk surgery when their back pain was due to arthritis of the spine or muscular in origin; not surprisingly, none of them got any better.
Diagnosis is often easy but at times very hard. A recent review of the disease endometriosis pointed out that there was an average of four to eleven years between a woman first complaining of her symptoms to her doctor and when a diagnosis was made. The National Academy of Medicine has estimated that every one of us is likely to be affected by a misdiagnosis, either in ourselves or a family member. It has certainly affected our family as I detail in Prescription for Bankruptcy. Many misdiagnoses are annoying but not serious, but misdiagnosis has been cited as the number one cause of malpractice suit payouts, and many studies over many years have shown that about 10% of hospital deaths are due to a missed diagnosis.
How can you minimize the likelihood that this will harm you or your loved ones? First of all, be honest and open with your doctors. There is very little you can tell them they have not heard before, and so be frank about your habits and behaviors. When you go for a visit, be sure to get your top priority up front. These days too many doctors are on a treadmill, with limited time for each patient. If you are going in for follow-up of a known problem but you have a new worrisome complaint, get it out there right away. If the doctor thinks they have finished and are about to move on, your new complaint is not likely to get the attention it may deserve.
There are many on-line tools that doctors can use to broaden their approach to diagnosis. I have worked on one, a decision support tool called DXplain, for several decades, and there are others. These can be very useful but they are under-used because doctors are too confident in their own acumen to know when they need to seek help.
When the doctor tells you of a new diagnosis, be prepared to ask them why they think that is what you have: what symptoms or physical exam findings support it. Since the leading cause of misdiagnosis is that the doctor settled on the first explanation for your complaints and did not consider other possible causes, ask them what else it could be – force them to open their mind and at least consider other possible conditions. If they suggest a treatment for this new diagnosis, ask them what you should expect; when you should see improvement and when you should call or return if you do not see improvement. Finally, if you are given a serious new diagnosis, or if the doctor brushes off your complaints as something minor when you are sure it is more serious, do not hesitate to get a second opinion. Second opinions are often very useful. If the second doctor concurs you will have peace of mind, and in many cases they may come up with a better explanation for your complaints.

Prescription for Bankruptcy. Buy the book on Amazon

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