July 23, 2014

Doctors’ Misdiagnoses: Why They Happen, How You Can Help Prevent Them

Estimates suggest that doctors make the wrong diagnosis during 10-15 percent of their patients’ office visits for new problems. So, if you’ve seen your doctor for about eight different issues in your lifetime, the odds are he’s misdiagnosed your problem at least once.

As reported in a recent Consumer Reports article, those misdiagnoses don’t involve uncommon or rare conditions… which might be understandable. According to a March 2013 study of 68 different cases in which doctors’ analyses were wrong, the issues they most often mis-identified -- or overlooked, or diagnosed late -- were these five common problems:
  1. Cancer (metastatic, or leukemia, lung, or pancreatic)
  2. Pneumonia
  3. Congestive heart failure
  4. Kidney failure
  5. Urinary tract infection
Doctors make those mistakes twice as often in their offices than in hospitals. But incorrect verdicts carry more severe consequences in hospital settings, since patients are already sick enough to be there.

Doctors at Johns Hopkins Hospital in Baltimore studied the problem of misdiagnoses, and their conclusions were published in the August 2013 issue of BMJ Quality and Safety in Health Care. Those doctors estimated that as many as 160,000 hospitalized patients die every year because healthcare professionals did one of these things:
  • Misdiagnosed a problem.
  • Made a late diagnosis.
  • Missed the problem altogether.
There are many reasons that contribute to faulty analyses by doctors, and those reasons typically occur in combination:

  • On average, a doctor’s visit lasts only 21 minutes.
  • Information that patients share with doctors is incomplete or unclear.
  • Doctors are interrupted by staff members during visits with patients.
  • Doctors are rushed because of heavy caseloads.
  • Staffers enter incorrect information in patients’ electronic records, misleading doctors.
  • Lab results or radiology tests are wrong or misleading in 2-4 percent of all cases.
  • Patients miss appointments or don’t get tests their doctors suggest.
  • Patients don’t take their pills… and don’t tell doctors about it.
In his book How Doctors Think, Dr. Jerome Groopman identifies three “pitfalls” that could cause doctors to misdiagnose a problem. They might:
  • Pin their diagnosis to the first piece if information a patient provides.
  • Muddy their decisions based on other cases where patients described similar issues but often with less serious problems.
  • Allow stereotypes – a patient’s appearance, speech, or dress, for example – to drive their diagnoses.
The Consumer Reports article provides strategies for patients to maximize their chances of getting a correct diagnosis:
  • Make appointments early. A doctor’s appointments early in the day are less likely to have time-crunch issues.
  • When making appointments, request a longer office visit time if the issue seems more complicated.
  • Arrive prepared, by listing and prioritizing complaints and symptoms in advance.
  • Include all meds and supplements in written recaps to doctors.
  • Bring a “buddy” to appointments to help listen and record information. Doing so also sends a message to doctors that you consider your issue important.
  • Ask targeted questions: “Why do you think that?” “Could my problem be something else?”
  • Expect a carefully reasoned analysis. If it doesn’t make sense, politely challenge it.
  • Insist on a diagnosis. Be clear about next steps.
  • Take charge of – and understand -- all test results. “What does it show?” What else might it mean”? "When should I expect to see results?”
  • Ask to see your electronic file. It may have incorrect or incomplete information.
  • Carefully monitor progress. Insist on a clear treatment plan.
  • Ask for a second opinion if you lose faith in a doctor, or if symptoms don’t improve after a reasonable interval. Doctors are required by law to cooperate in such requests for additional opinions.
Here's the bottom line: Be the CEO of your own healthcare. You’re much more likely to get the results – and the relief – you seek.

No comments: