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I have been a registered nurse, nurse practitioner and most importantly a patient advocate for over 20 years. I have worked in hospitals, homes and as a private consultant, always teaching patients how to speak up for themselves and to make well informed healthcare decisions that are right for them and help them to avoid all types of Medical Errors. The many things I have seen in healthcare led me write "What Did the Doctor Just Say." In it are all the steps every patient needs to take to remain safe in the healthcare system and avoid medical errors. My personal goal is help to save 100,000 people from the horrors of a medical error and I wrote What Did the Doctor Just Say? to help make that happen.

Wednesday, December 23, 2009

Up to 40% of Medical Diagnosis Are Wrong! Here's Why

In fact missed and wrong diagnosis are among the most common types of medical mistakes. An evaluation of 53 autopsy studies found up to 40 percent of the cases reviewed had a major diagnostic error and that the patients may have lived had they gotten the correct diagnosis and subsequent right treatment. The rates of diagnostic error are even higher in emergency rooms and in intensive care units, were rapid decisions must be made.
      And these are not just numbers, real people are affected by diagnostic errors. A 1997 study conducted by the National Patient Safety Foundation found, 40 percent of the patients surveyed stated they or someone they knew had been involved in an incident involving a diagnostic error. Once you receive a wrong diagnosis the treatment (medications, surgery, chemotherapy, tests and procedures) associated with that wrong diagnosis are wrong as well. Additionally the right treatments will probably be delayed and those delays could really cost you, big time, especially in cases where an early diagnosis could me cure and a delayed diagnosis could mean you will not be cured.
Both patients and providers contribute to the making of a wrong diagnosis. In this post I will discuss some of those reasons and the types of diagnostic errors.

Types of Diagnostic Errors
A wrong diagnosis. The diagnosis you are given inaccurate and has no relationship to the condition you actually have.
You are not sick. You are diagnosed with an illness when you do not have an illness.
Missed diagnosis. You are told you do not have a illness when, in fact, you do have an illness. The doctor “missed” the diagnosis.
Missed underlying disease. In this scenario the provider fails to diagnosis the underlying cause of your chief complaint. If, for an example, you are given the diagnosis of headache and the doctor fails to diagnose the high blood pressure that is causing the headache, the high blood pressure becomes a missed underlying disease.
Missed complications. Many diseases have complications; for example, complications of diabetes include ocular disease, kidney failure, and cardiovascular disease. If the doctor does not screen the patient for these complications and they are allowed to progress without intervention the patient will eventually develop the complications associated with their primary diagnosis because in part, the doctor failed to properly screen for and detect these underlying problems.
Missed medication side effects. Both prescription and over-the-counter medications have side effects. For example, an over dose of non-aspirin pain relievers can cause liver failure. Use of steroids can cause brittle bones and mental agitation. The list of medication side effects goes on and on. Medication side effects can be overlooked and diagnosed as a new disorder, when, in fact, the symptoms could be relieved by stopping or changing the medication.
There are many reasons why doctors choose the wrong diagnosis and there are things patients say and do that contribute to a wrong diagnosis. Below I have outlined some of these things and given you the steps you can take to increase the probability you’ll get a correct diagnosis. Let’s get started.
Provider Reasons for Making a Wrong Diagnosis
Lack of time. The average length of an office visit is 15 minutes. This means the doctor has to process a good deal of information in a very short period of time, making it easy to overlook or to forget things. The short office visit leaves no time to research and learn more about the patient’s complaints. In short, rapid-fire visits increase the probability of getting a wrong diagnosis.
Two diseases have similar symptoms. If the provider has to choose between two conditions with similar symptoms, she could choose the wrong one .
There may be two diseases going on at once. If you have two disorders, one may be overlooked and go undiagnosed and untreated.
Inability to understand the patient. When the doctor does not understand the patient for any reason, the information the patient gives can be misunderstood. The patient could easily be given a wrong diagnosis.
The doctor did not know about the disorder. There are more than 20,000 human diseases. Doctors will know the most common diseases and the ones they see most often. They will not know about disorders they have never seen or been taught about. Because the doctor cannot know everything, unusual and unfamiliar disorders are sometimes missed.
Provider skill level. Some doctors have highly developed diagnostic skills; they are knowledgable; they have experience; and they trust their instincts. Others are not so well endowed, and thus they are not as skillful in the art of making an accurate diagnosis. In addition, doctors who are experts in their area of specialty will be better at diagnosing disorders in their area of expertise than someone who is not an expert in diagnosing the disorder.
Over-publicized diseases. A disease that receive a lot of publicity tends to be over-diagnosed in the doctor’s office.
Doctor bias. When providers routinely see a disease in their practice, they may habitually assign that diagnosis to patients without looking any further for an alternative cause of the patients complaints. The doctor may overlook additional symptoms that would lead to a different diagnosis.
Rare or unusual diagnosis. When a condition is rare or unusual for the age and sex of the patient, the diagnosis may be overlooked or missed all together. Many women, for example, are misdiagnosed when they present to the emergency room with a heart attack because of the persistant myth that says heart attacks are rare in women. Furthermore, women tend to present with unusal symptoms when they experience a myocardial infarction; as a result, the diagnosis is missed.
The diagnosis does not have a definitive diagnostic test. Without tests to confirm or refute a diagnosis there may be no way to be certain the diagnosis is correct.
Cost. Some doctors will avoid expensive tests and tests that are not covered by your insurance company in order to reduce costs. In addition, the doctor may not order tests that diagnose rare conditions because he may believe there is a very low probability of you having the disorder. This works well for the large majority of patients, but fails for the small percentage of patients who have rare conditions. This minority could have their ailment diagnosed had cost not prohibit testing.
Mental illness. Patients who are mentally ill or confused and those who suffer with dementia are difficult to diagnose because they are unable to clearly communicate their symptoms. As always, communication is an essential element in every area of healthcare safety.
Things Patients Do That Can Lead to a Wrong Diagnosis
Patients Withhold information. Patients withhold information because they are uncomfortable discussing “personal problems” and because they are afraid of the consequences of telling the truth. Not revealing information related your condition could result in a wrong diagnosis and delay proper treatment.
In the following example, a man goes to the doctor with palpations and chest pain and his doctor cannot determine the cause of his problem. The doctor orders more tests and procedures and requests a second opinion. All the while, the patient has a secret: he is addicted to cocaine. Cocaine causes palpations and its abuse can lead to a heart attack, stroke, seizures, and death. Because the doctor does not know about the cocaine, he cannot properly diagnosis and treat the patient or help him get into a recovery program that may save his life. Withholding information can lead to a wrong diagnosis, delay proper treatment and could have lethal consequences!! There is a saying that goes “You are only as sick as your secrets.” It fits here.
Your role as team leader:
  • Choose a doctor you can trust, one with whom you can be honest.
  • Tell your doctor about any activities or symptoms you have that you believe are related to your medical condition.
  • Volunteer the information even if you feel the information is personal and should be kept private. Even if no one asks, if you feel the information you are withholding bears on your medical condition, tell your doctor. This will help you to get an accurate diagnosis and timely treatment.
Sometimes patients delay reporting symptoms. Patients wait weeks, months, and even years to report symptoms. Many do not want to go to the doctor or because they are afraid of receiving a diagnosis and treatment plan.
Your role as team leader:
  • If something goes on without improvement seek help.
  • Keep a record of and report your symptoms using the O.L.D.C.A.R.T.S format. This will help you to give a complete and coherent account of symptoms you may have had for a long time
  • Research your symptoms on a symptom checker and report your findings to the doctor.
Sometimes patients are hypochondriacs. Dr. Paul Tornier once said, “Many ordinary illnesses are nothing but the expression of a serious dissatisfaction with life.” Sometimes patients have multiple and frequent complaints and their doctors are unable to diagnose a physical condition. In some of these cases, the patients are thought to be hypochondriacs. When a patient is labeled a hypochondriac, high suspicion among healthcare providers erupts that there are emotional or psychological problems that are generating physical discomfort. This is not at all uncommon. Something as simple as a headache can be the result of constant worry. To some degree, all of our physical complaints have a psychological effect on our lives.
There are, however, potentially very serious problems associated with frequent trips to the doctor’s office. Among them is that sooner or later the patient will be given a diagnosis, possibly for a condition that does not exist. Patients who frequent the doctor’s office have the likilhood of being exposed to tests and procedures that have their own risk factors.
Your role as team leader:
  • If you find yourself frequently at the doctor’s office for one complaint or another and there is no clear diagnosis, consider seeing a therapist to be evaluated for stress, anxiety, depression, and loneliness. All of these are common causes of physical discomfort and require their own treatment plan to bring relief.
Sometimes patients try to commit fraud to get time off work and to gain other benefits. Faking is dangerous and exposes the faker to the possibility of medical error. In this example, the patient consents to and has an unnecessary CAT scan because the doctor is trying to find a reason for his abdominal pain (which he doesn’t have). Sounds harmless right? Well let’s see about that. The dye or contrast used during the test sends the patient into kidney failure. That’s right – contrast dye can damage the kidney, possibly for life. Patients have also been known to have fatal allergic reactions to contrast agents. All medications, tests, treatments, and procedures can harm as well as help. The medical system is not to be entered into lightly. Be careful and do not expose yourself risk.
Your role as team leader:
  • Do not fake symptoms for any reason.
  • Do not expose yourself to unnecessary test and procedures.
Sometimes patients push providers for unneeded medications. While this is not a wrong diagnosis, insisting the doctor give you a prescription that is not necessary leads to the wrong treatment and exposes you to possible medication side effects that can alter your life. Over using antibiotics can cause resistance to them, and they may be rendered ineffective when you really do need them. Over using antibiotics also leads to the development of a very serious infectious gastric disease known as C-Difficile. And, last but not least, contiuned overuse of antibiotics will decrease the functioning of your immune system. If your provider feels you do not need an antibiotic, it is best to accept his opinion and try other measures to treat your condition.
Likewise, the over use of pain medication can cause life-long issues with addiction and make existing problems like depression and bowel disorders much worse. If your doctor does not want to give you a medication and has a sound rationale – a reason you can understand that synchs with your honest feelings about what is going on – you will be safer if you listen to the provider.
Your role as team leader:
  • Take antibiotics only when really needed.
  • If you find yourself seeking mood-altering substances in the doctor’s office you may want to get help. Addiction is a horrible condition that keeps you chained to a doctor or an illegal supplier.
  • If you need help dealing with an addiction, get it. Set yourself free from the prescription pad.
To learn more about how you can protect yourself and your loved ones from the dangers of a misdiagnosis, get a copy of What Did the Doctor Just Say?: How to Understand What Your Doctor Is Saying and Prevent Medical Errors From Happening To You and Your Loved Ones. Just click the link.

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