fff >From: "Artemis, Diana T (US SSA)" <diana.t.artemis@...> >To: <mail@...> >Subject: Misdiagnosis occurs more frequently than patients realize >Date: Fri, 14 May 2004 12:53:53 -0400 > >Misdiagnosis occurs more frequently than patients realize > >BY KYUNG M. SONG >The Seattle Times > >Nearly one out of four female patients in Washington state who have their >appendix removed turn out not to have had appendicitis. Research in California >and Michigan showed cardiologists miss a third of the evidence for significant >heart disease. >And in a 1998 experiment led by the University of Chicago, radiologists at a >breast-cancer conference on average failed to detect or gave false positive >results for 30 percent of the mammograms -- including one radiologist who scored >just 8 percent correctly. > >In fact, misdiagnoses occur much more frequently than patients may realize. >Diagnostic errors have triggered more malpractice suits in the past two decades >than any cause except improper medical treatments. > >The true scope of incorrect diagnoses is difficult to measure; some mistakes >get buried with patients. But a 1983 study of 100 randomly selected autopsies >that ran in the New England Journal of Medicine discovered that physicians had >missed a major diagnosis in 22 percent of the dead. > >Medicine is too complex for doctors to avoid mistakes 100 percent of the >time, says Dr. Doug Paauw, associate professor of medicine at the University of >Washington. > >"That standard is unachievable," Paauw said. "Even a well-trained and >excellent doctor makes errors." > >That means passive patients, those who never question, could be jeopardizing >their health -- perhaps their lives. > >To get the most from their medical care, patients should -- in addition to >describing symptoms clearly, asking questions and following all treatment orders >-- take action if something doesn't feel right, even if it means >second-guessing their doctors. > >Paauw estimates that a typical doctor makes as many as 1,000 decisions daily, >from authorizing a prescription refill to weighing whether to refer a patient >to a specialist. > >Some symptoms can leave doctors stumped or lead them astray. A patient may >have a rare condition the doctor has never seen. Or symptoms may mask the >underlying malady. > >For instance, a depressed patient may complain of lack of energy or >headaches, which could be caused by any number of conditions, but the patient may not >describe feeling persistent sadness. Someone with a blood clot in the lungs may >describe shortness of breath, which also occurs with asthma and other >respiratory ills. > >Sometimes, doctors rely on subjective judgments rather than empirical data in >making diagnoses. For example, in 1999, medical records of 599 male patients >from Palo Alto, Calif., and Birmingham, Mich., were sent to 142 physicians to >look for signs for heart disease. Fifty-eight percent of the men had >significant heart damage detected by an angiogram, an X-ray exam that involves >inserting a catheter into the blood vessel to check for blood flow. > >The doctors were given results from patients' treadmill tests to gauge heart >function as well as clinical data -- but not the angiogram -- and asked to >estimate the probability of coronary-artery disease. Of the "expert" >cardiologists, 69 percent scored accurately, compared with 65 percent for the other >cardiologists and 66 percent for the internists. Nearly a third of the estimates >were wrong. > >Sometimes the trickiest diagnoses can happen when symptoms don't follow the >common pattern for a condition. Appendicitis typically causes pain in the lower >right side of the belly, where the pouchlike appendix is connected to the >intestine. But some patients hurt on the left side, or in the back. > >What's more, other ailments can mimic appendicitis. An inflamed lymph node in >men or an ectopic pregnancy in women can produce similar symptoms. > >In Washington state, thousands of appendixes are removed unnecessarily each >year. Dr. David Flum, a University of Washington surgeon, and three other >researchers analyzed nearly 64,000 appendectomies performed in Washington hospitals >between 1987 and 1998. They concluded that 9,880 patients, 15.5 percent, did >not have appendicitis, meaning the surgeries were unnecessary. Among female >patients, 22.8 percent were misdiagnosed, Flum said. > >The findings were published in the October 2001 edition of the Journal of the >American Medical Association. > >Flum said surgeons have traditionally accepted that 15 percent to 20 percent >of all appendectomies will turn out to have been unneeded. His research showed >that the accuracy rate did not improve during more than a decade despite the >introduction of new diagnostic tests such as computed tomography -- CAT scans >-- and ultrasounds. > >Flum estimates unnecessary appendectomies cost Americans as much as $1 >billion a year, not to mention post-surgery complications and the mental toll of >being misdiagnosed. And appendicitis is just one of a multitude of illnesses that >are misdiagnosed. > >"People often confuse clinical medicine with hard science. But it's not. >People interpret data differently, or misinterpret data," Flum said. > >Paauw, who teaches third-year medical students at the University of >Washington, says doctors commonly make mistakes through "premature closure." > >"Someone sees a pattern and says, 'I know what that is' and jumps right into >a diagnosis," said Paauw, who co-wrote a 1996 article for Resident & Staff >Physician on ways to reduce diagnostic errors. > >Paauw said doctors who don't listen to patients closely and don't get good >medical histories set themselves up for errors. It's the same when doctors >depend too much on charts and other written data, which can be incomplete, >inaccurate or misinterpreted. > >Diagnostic tests, too, can be faulty. Dr. Daniel Stryer is a director with >the Agency for Healthcare Research and Quality, the U.S. government's lead >health-services research arm. Stryer says sometimes simple human error is to blame, >as when a pathologist misreads a biopsy result. > >But more often, the diagnostic tests themselves are unreliable. For instance, >an electrocardiogram, or EKG, used as the first test to detect heart attack >misses 43 percent of actual heart-attack cases, Stryer said. A treadmill test >can yield more definitive results but isn't wholly accurate, either. > >Only cardiac catheterization, which involves inserting a thin tube into an >artery or a vein, qualifies as the "gold standard" test that can accurately >measure the blood flow, Stryer said. > >Many lab tests, including PAP smears and HIV tests, can give false results, >positive or negative. > >"With every diagnosis, there is an element of uncertainty," Streyer said. "It >may sound like a horse, smell like a horse and look like a horse. But in >fact, it's a zebra." > >When errors are made, Stryer said, doctors more commonly diagnose a condition >the patient doesn't actually have than mistakenly give a clean bill of >health. That's because "most times, people leave (the doctor) with a diagnosis" of >some kind, Stryer said. "We have to put a label on it." > >Misdiagnoses are just one type of medical error. Others include mistakes with >medications (giving the wrong drug or dosage or in wrong combinations) or >errors in treatment (operating on the wrong limb, improper transfusion) or >failure to anticipate complications such as infections. > >Medication errors in particular are a growing problem. A 1999 report by the >Institute of Medicine called "To Err is Human" estimated that 7,400 Americans >died in 1993 from drug errors. > >Stryer said patients must have trust in their doctors -- otherwise, they >should look for other physicians -- but there is nothing wrong with questioning >doctors about the care they give. The most helpful thing you can do for your >doctor is to give him or her a thorough description of your symptoms. > > >PATIENT ADVICE > >Following are tips for preventing inaccurate diagnoses: > >-- Don't wait to see a doctor if you don't feel well. Doctors can't make a >diagnosis -- right or wrong -- unless they examine you. > >-- Be accurate and thorough in describing your symptoms. Keep a written >record, if necessary, to remember the details. Getting an accurate medical history >is especially critical if the patient is an infant, doesn't speak English or >suffers from depression or mental impairment. > >-- Ask your doctor for the medical term for your condition. This will help >you research your disease. > >-- Call back for your test results. Don't assume no news is good news. > >-- Ask for a copy of your medical records and check for errors. > >-- Check out the hospital before scheduling your surgery. Hospitals that >handle a high volume of particular procedures generally, but not always, are >better. Ask the hospital or the doctor about track records. > >-- Don't follow a doctor's orders blindly if your symptoms persist or worsen. >If necessary, return to your doctor instead of waiting until the next >scheduled appointment. > > >Click here to return to story: >http://www.charleston.net/stories/050304/sci_03diagnose.shtml > >