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The Prescott Daily Courier | Prescott, Arizona

home : features : features November 25, 2015

6/30/2013 6:00:00 AM
THE GOOD PATIENT: Avoid being snared by the most common medical error
Elizabeth Bewley
Courier Columnist

What would you guess is the most common mistake doctors make? Operating on the wrong arm or leg? Prescribing the wrong drug because they mix up two drugs with similar names? Accidentally nicking one organ while operating on another?

No, no and no.

The most common medical error, according to a recent study, is misdiagnosis. Researchers came to this conclusion by studying more than 350,000 medical malpractice cases in the U.S. that patients won, spanning 25 years.

They found that misdiagnosis accounted for nearly three out of every 10 successful malpractice claims. You might think that most of the misdiagnosis happened in hospitals - after all, that's where critically ill patients are. But in fact, nearly seven out of 10 paid claims based on misdiagnosis were related to care that occurred outside of the hospital.

About half the patients died; many of the rest experienced serious, permanent harm. The researchers noted, "Among malpractice claims, diagnostic errors appear to be the most common, most costly and most dangerous of medical mistakes."

One of the authors of that study was quoted as saying, "This is an enormous problem, the hidden part of the iceberg of medical errors." Researchers report that 80,000-160,000 people each year are permanently disabled as a result of misdiagnoses.

Doctors are taught, "When you hear hoof beats, think 'horse,' not 'zebra.'" That is, they are to assume that symptoms are caused by an ordinary illness or injury, not by a rare and exotic one.

So were most of these diagnostic errors due to failures to recognize the infrequently-seen zebras? No, a Kaiser Health News report noted, "Studies repeatedly have found that diagnostic errors, which are more common in primary-care settings, typically result from flawed ways of thinking, sometimes coupled with negligence, and not because a disease is rare or exotic."

They also note that most errors, diagnostic or otherwise, don't result in lawsuits, and that doctors typically don't even know that they've made a mistake; the patient often simply seeks care elsewhere. They quote one commentator who suggested that at least half a million diagnostic errors are made each year in the U.S.

What can you do to avoid being misdiagnosed?

The first step is to provide as much relevant information as you can, to help your doctor come up with the correct diagnosis from among the more than 68,000 different diagnoses that the U.S. medical system recognizes.

Information to provide includes a detailed list of all drugs, vitamins, and supplements you are taking (see my article, "Make a list of your medications before a doctor's visit," in the June 23, 2013 Daily Courier); a one-page summary of your present problem (see my article, "Bring list of questions, concerns to doctor appointment," in the June 16, 2013 Daily Courier); and perhaps a concise summary of your medical history.

At a minimum, your medical history would include major events, such as a heart attack or broken bone; hospitalizations; operations; current diagnoses (such as high blood pressure or asthma), the doctors treating those conditions, and any treatments you are currently getting not already listed (such as physical therapy).

The second step in getting an accurate diagnosis is to ask questions if you are unsure whether the diagnosis really fits. Dr. Jerome Groopman offers three questions in his book about misdiagnosis, "How Doctors Think." These are: What else could it be? Is there anything that doesn't fit (meaning any symptom, findings upon examining you, or test result that isn't explained by the diagnosis)? Is it possible that I have more than one problem?

The third step is to make sure you understand and have a written record of the doctor's instructions, and know when you should start to feel better and what to do if you don't improve. Often, a repeated failure to improve when given several different treatments is a hint that you don't have the condition for which you are being treated.

The fourth step is to make a good faith effort to follow the care instructions you've been given, to track any new symptoms that arise, to notice if you feel better or not - and to follow up as agreed with your doctor.

Elizabeth L. Bewley's new book is available locally at Hastings and at The Peregrine and online at Amazon. This collection of 40 articles from the column "The Good Patient" in the Daily Courier is titled," Not Your Grandmother's Nursing Home: Demystifying Today's Retirement Living Options."

To tell Elizabeth your story or to ask her a question, write to:


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Reader Comments

Posted: Tuesday, July 02, 2013
Article comment by: SO S

Thanks for the wise words.

Posted: Tuesday, July 02, 2013
Article comment by: Computers Would Diagnose Better

As long as doctors continue to diagnose and treat by the tests instead of using their own eyes, ears, and hands, a computer could do a far better job.

Since doctors are not about to start using their own senses as tools of the trade, we might as well just skip them entirely and enter our symptoms at a computer terminal at the pharmacy counter. That's essentially what is going on now.

With electronic medical records, the doctors don't even look us in the eye when talking to us because they are looking and typing into their computer screens so they can meet the standards of the insurance companies to get maximally reimbursed. It's a business game.

Remember the days when a doctor would routinely look into our eyes with an opthalmoscope? You can actually gain a lot of information about the cardiovascular system from looking at the blood vessels in the eyes before problems get severe.

Take care of your own health, and don't expect good health care in this country, no matter if you are insured or not. It's a money-making game with lots of players and we are the pawns.

Posted: Tuesday, July 02, 2013
Article comment by: Sharon Jones

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