In a recent article in the Wall Street Journal (“The Battle Against Misdiagnosis” ) Dr. Hardreep Singh provided some interesting insight into the causes of misdiagnosis. According to one conservative study, at least 12 million adults are misdiagnosed each year while seeking medical treatment. Although this only represents a 5% error rate, it is still significant if you are one of the 12 million misdiagnosed patients.
Typical examples of misdiagnosis that we have encountered include things like an ankle fracture being diagnosed as a sprain; appendicitis being diagnosed as kidney stones; an anaphylactic reaction being diagnosed as a heart attack; pneumonia diagnosed as an upper respiratory infection; malignant melanoma diagnosed as a subarea keratosis; and meningitis diagnosed as an ear infection. To varying degrees each of these situations resulted in the patient having a much worse outcome than had the correct diagnosis been made sooner. In many of these situations, there was nothing the patient could have done differently. However, this article does correctly point to the steps that every patient can take to prevent or minimize the adverse effects of a misdiagnosis.
One of the primary causes of misdiagnosis is poor communication between the patient and the doctor. The patient is usually the best source of information when it comes to helping the doctor make the correct diagnosis. So it is important when you are a patient to make sure the doctor is aware of your relevant medical history. However, you may encounter a situation where your doctor hurries through the patient history and/or physical exam which can lead to a missed diagnosis. The article attributes the problem hurried evaluations to “time pressures and paperwork” that limit the doctor’s time with the patient. The article also criticizes the reimbursement system for not sufficiently compensating primary care doctors for spending the extra time necessary to search for the correct diagnosis. However, one factor not address is the physician’s desire, for economic reasons, to see as many patients as possible in the shortest time possible.
Regardless of the reason your doctor may be pressed for time, as a patient it is important you ultimately must be satisfied with the interaction between you and your doctor. If for any reason you feel that the diagnosis does not fit your symptoms, you need to ask your doctor questions and insist on more time. If you are still not satisfied, then the best course is to seek a second opinion. Of course, there are many reasons that you may not get a second opinions. These include the fact that it is an additional cost, it takes additional time you may not have, and it can be difficult to even find another doctor in your network who will see you.
An interesting fact when it comes to second opinions is that you are more likely to see another doctor when the misdiagnosis results in your doctor telling you that you have a more serious medical condition than you actually have rather than when the opposite situation occurs. While an over diagnosis can result in unnecessary medical treatment — and can still be dangerous, the more serious situation is usually when the misdiagnosis lead to you being diagnosed with something that is less serious than what you actually have. In this situation, you are less likely to seek a second opinion because you want to believe the doctor is right. However, this can result in a life threatening delay in receiving the right treatment.
Finally, the article suggests that patients with ongoing medical problems need to keep good records of each meeting with their doctor. It is important for patients to bring that information when following up or when referred to another doctor. The article also cautions patients that “[n]o news from a doctor is not necessarily good news.” Sometimes when tests are run, there may be a procedural breakdown where significant results are not timely reported to the patient. So the patient should always make sure to follow up to find out the results of all tests.