HOW TO AVOID MISDIAGNOSIS

Doctor_discusses_x-ray_with_patientA recent article in the Wall Street Journal by Hardreep Singh titled “The Battle Against Misdiagnosis” provided some interesting insight into the subject of misdiagnosis. According to an apparently conservative study, every year at least 12 million adults are misdiagnosed while seeking medical treatment. Although this number only represents an estimated 5% error rate, 12 million misdiagnosed patients is still significant.

Typical misdiagnosis cases that we have encountered over the years 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 a much worse outcome for the patient. In many of these situations, there was nothing the patient could have done to prevent the misdiagnosis or the damage that resulted. However, there are steps that every patient can take that will help prevent or minimize the adverse effects of a misdiagnosis.

The article notes that one of the primary contributing causes of misdiagnosis is poor communication between the patient and the doctor. In most cases, the patient is the best source of information when it comes to helping the doctor make the correct diagnosis. So it is important for the patient to make sure the doctor is made aware of the relevant medical history. However, there may be times where your doctor hurries through the patient history and/or physical exam which can lead your doctor to miss the correct diagnosis.

The article attributes hurried evaluations to external “time pressures and paperwork” that limit the doctor’s time with the patient. The article also in our view rightly criticizes the reimbursement system for not sufficiently compensating primary care doctors for spending the extra time necessary to search for the correct diagnosis. However, another potential factor contributing to hurried patient examinations that was not discussed involves economics and the physician’s desire to see as many patients as possible in the shortest time possible.

Regardless of the reasons your doctor may be pressed for time, as a patient it is important to make sure you are satisfied with the interaction between you and your doctor. If for any reason you feel that your doctor is distracted or rushed or that the diagnosis does not fit, you need to ask questions and insist on more time. If you are still not satisfied then the best course is to seek a second opinion. But unfortunately, there are many reasons that patients do not get second opinions. These include the additional cost, the extra time it takes, as well as the difficulty in finding another doctor that is in your network.

Another interesting factor in the misdiagnosis discussion is that when it comes to second opinions, patients are more likely to see another doctor when the misdiagnosis results in the patient being misdiagnosed with a more serious medical condition than what the patient actually has than when the opposite situation occurs. While this can result in the patient getting unnecessary medical treatment, the more dangerous situation is usually when the misdiagnosis results in the patient being diagnosed with something that is less serious than what the patient actually has. In this situation the patient is less likely to seek a second opinion because the patient obviously wants to believe the doctor is right. However, this type of misdiagnosis can cause a life threatening delay in the patient receiving the needed 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.

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