Johns Hopkins Docs Say Diagnostic Errors a Threat to Patient Safety
Common and Deadly Medical Mistakes Include Incorrect Diagnoses
Going to the hospital is fraught with danger. Getting the wrong medication or the wrong dose can kill you—and does kill tens of thousands of people every year. One of the antibiotic-resistant bacteria that lurk in hospitals might get you. Your surgeon might operate on the wrong body part. Now add a misdiagnosis to the list of things that can go terribly wrong in the hospital.
One common example, made all the more poignant by the death of Natasha Richardson, is the misdiagnosis of a life-threatening head injury as a garden variety headache, and the prescription of some ibuprofen rather than a CAT Scan.
Another common example is a woman who is having a heart attack being misdiagnosed as having an anxiety attack and sent home with Ativan.
Commonly Misdiagnosed Illnesses Include Cancers, Heart Attacks and Infections
According to a commentary in the Journal of the American Medical Association (JAMA) by two doctors from Johns Hopkins who are patient safety experts, “…misdiagnosis accounts for an estimated 40,000 to 80,000 hospital deaths per year and… tort claims for diagnostic errors — defined as diagnoses that are missed, wrong or delayed — are nearly twice as common as claims for medication errors.”
They estimate that, “Opportunities to prevent disabling stroke are missed when patients experiencing mild or transient warning symptoms receive misdiagnoses. According to a recent systematic review, 9% of all cerebrovascular events [e.g. strokes] are missed initially, and the odds of misdiagnosis increase at least 5-fold when symptoms are mild or transient.”
The doctors add that rather than blaming the individual doctor, it’s more useful to examine and improve hospital procedures and protocols that lead to a diagnosis. While the experts figure out how to diagnose better, what’s a patient to do?
Be Proactive and Persistent
People who wind up in the emergency room are at the mercy of the doctor on call and the luck of the draw. After all, the irascible House is a TV character who typically takes a few days to solve a mystery diagnosis, after much sleuthing and drama with his crack team of young doctors. The reality of the typical emergency room is a doctor who is likely to be young, relatively inexperienced, short on sleep and stretched way too thin. Patients without health insurance are likely to receive fewer diagnostic tests and referrals to specialists. With this in mind, try to have someone there with you who will be proactive and persistent with the medical staff.
Accidents and sudden emergencies aside, diagnostic mishaps can be avoided by paying attention to troublesome symptoms before they become serious enough to require a trip to the emergency room. Some research on the internet and a scheduled visit to a doctor you know is vastly preferable and safer than the emergency room. If the doctor finds nothing wrong but your intuition says differently, seek a second opinion, or a third if necessary.
In the book How Doctors Think, Harvard physician Jerome Groopman describes a woman who spent 15 years being misdiagnosed with anorexia, bulimia and irritable bowel syndrome by dozens of doctors who did everything from give her psychiatric drugs to force feeding her. She was near death when a doctor finally diagnosed her correctly with celiac disease, a sensitivity to gluten, which is a protein found in grains such as wheat. At the time of the diagnosis she was being force fed a wheat-based gruel, and her severe cramps and diarrhea were attributed to psychiatric problems.
Try Alternative Medicine
There are some illnesses that conventional medicine is particularly poor at diagnosing and/or treating, most notably digestive problems such as celiac disease and food allergies; various forms of fatigue, autoimmune disorders and yes, hormone imbalances. In this case it might be worth it to find a physician who uses alternative medicine, or to turn to a Chinese medicine doctor, a naturopath or chiropractor.
A search on the internet can yield much helpful information, but you may have to sort through a lot of garbage to find it. Although many doctors disapprove of patients using the internet to diagnose themselves, it’s a tool that doctors often use. Armed with knowledge of your own body, habits and health history, the internet could help you decide, for example, whether your abdominal pain is caused by the onion rings you had for lunch or something more serious.
Be discriminating and cautious if a medical diagnosis site asks for a lot of personal information, charges a fee, claims to have online doctors, or wants you to buy information with a miracle cure.
Two useful medical diagnosis sites are:
References
Newman-Toker DE, Pronovost PJ, “Diagnostic Errors—The Next Frontier for Patient Safety,” JAMA. 2009;301(10):1060-1062.
Diagnostic Errors: The New Focus of Patient Safety Experts: JAMA commentary highlights problem, suggests solutions to reduce the number of diagnoses that are missed, wrong or delayed. Johns Hopkins Medicine News and Publications: http://www.hopkinsmedicine.org/Press_releases/2009/03_10a_09.html.
“Patients, Doctors and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York,” Harvard Medical Practice Study 1990.