How Not To Be Misdiagnosed
You Can Help Your Doctor Prevent A Fatal Mistake
As many as 15% of medical diagnoses are wrong. You’re told you’re fine when you’re really ill or that you have a disease you don’t really have. Either result can be fatal.
In a study reported in Annals of Internal Medicine in October 2006, doctors at Harvard School of Public Health analyzed more than 300 incorrect diagnoses. They found that 59% of these misdiagnoses seriously harmed the patient in some way, and of those, 30% were the cause of death.
In the study, the most commonly missed diagnoses were breast and colorectal cancers, fractures and infections. These probably were reported most often because they are common problems that have significant negative consequences if missed.
Other health problems missed were those with vague symptoms—such as fatigue—that make it difficult for the doctor to quickly arrive at a precise diagnosis. Diseases in this category include multiple sclerosis, thyroid disease and certain cancers.
Here’s how to help your physician make the correct diagnosis…
TELL YOUR STORY WELL
Doctors are medical detectives. They decipher clues from evidence, such as a physical exam or laboratory tests. Much of that evidence is rooted in your medical history—the story you tell your doctor about your health. Don’t try to diagnose yourself. Simply tell your story clearly, completely and accurately. Include the following…
Timing. When did the problem start? How long has it been going on?
Symptoms. Describe your symptoms in detail. For example, is pain localized or general…mild or severe…intermittent or constant? What seems to make your symptoms better or worse—eating, activity, time of day?
Tests. Explain the tests that have been done and the results.
Treatments. Which treatments have you tried? Did they help?
Trap: A nurse or health technician may interview you before you see the doctor. Don’t assume that he/she will relay your story to the doctor complete-ly. Instead, let the doctor hear all of the information firsthand.
KEEP CAREFUL RECORDS
Maintain your own medical records by writing down relevant facts about your condition. Include test results, an accurate list of all current medications (prescription and over-the-counter) and supplements, reports from specialists and hospital admissions. Bring your records to every doctor’s visit. Even if you’re seeing the same physician, it’s not unusual for your records to be unavailable for one reason or another.
If you’re seeing a new doctor, even one within the same health-care system, don’t assume that he/she will get your medical records. Confidentiality rules make it difficult to move records from one doctor to another.
GET TEST RESULTS
Ask for your test results. No news might not be good news. Perhaps the doctor is out of town or sick, and your results are sitting in the office—this can be dangerous if you have a life-threatening disease. Know when test results are due. If you don’t receive them on time, call the doctor’s office. Even better: Ask your doctor if the lab can send the results to you as well as to the doctor.
KNOW WHAT’S NEXT
A doctor might say, “I’m pretty sure this is what you have.” At that point, ask what is likely to happen to you next if his diagnosis is right. If what the doctor expects to happen does not happen, the diagnosis may be wrong.
Example: A longtime smoker catches a cold, and the cough persists for two weeks after the other symptoms have disappeared. The doctor might say, “I think you have bronchitis, which should resolve itself over the next two to three weeks. If not, get back to me.” If the cough persists, the patient may have another more serious problem, such as heart failure or lung cancer.
ENCOURAGE YOUR DOCTOR TO THINK BROADLY
Experts who study misdiagnosis are fond of the following joke—What is the most commonly missed fracture? Answer: The second fracture.
In other words, when a doctor finds a fracture or some other type of health problem, he may stop looking. This type of error has been dubbed satisficing—a doctor feels satisfied by finding one problem and stops looking for other problems. Satisficing is a common error. To help prevent it, ask your doctor, “What else do you think this could be?”
GET A SECOND OPINION
Give your primary care physician the first opportunity to diagnose and treat your problem, but if symptoms persist, you might want to get a second opinion. Ask your primary care physician for a recommendation.
Help everyone involved in your care to know what the other providers are thinking and planning. Don’t assume that health professionals are coordinating your care behind the scenes—they probably aren’t. You are the most reliable person for that job
Bottom Line/Personal interviewed Mark Graber, MD, associate chair of the department of medicine at Stony Brook University, New York, and chief of medicine at Veteran’s Administration Hospital in Northport, New York.
Dr. Graber is widely recognized as a leading authority on diagnostic errors in medicine, and his scientific papers on the topic have appeared in Archives of Internal Medicine, Academic Medicine and other journals.
(Article originally published August 1, 2007)
Reprinted with the permission of:
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